Utilization Review Specialist – LPN Required

Job not on LinkedIn

🔥 2 minutes ago

🏄 California – Remote

🏄 California – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Medusind

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💼 Consulting

📦 Logistics

🏭 Manufacturing

💰 Debt financing on 2023-05

Consulting • Logistics • Manufacturing

Medusind is a healthcare revenue cycle management (RCM) and business process outsourcing company that provides end-to-end and point solutions for medical and dental providers. It offers medical and dental billing, coding, credentialing, accounts receivable and denial management, supply chain and accounts payable services, plus proprietary SaaS products (MedClarity, Dental QuickVerify) and analytics to improve collections and operational efficiency. Medusind serves physician groups, hospitals, FQHCs, behavioral health facilities, dental practices and DSOs, emphasizing technology-driven, scalable services and automation to maximize provider revenue.

📋 Description

• Lead training for new onshore Representatives and oversee development of payer-specific training materials • Conduct CDI and documentation standardization training across customers • Partner with QA to perform ongoing utilization review audits and monitor accuracy trends • Provide educational feedback to facilities on supporting documentation required for authorization approvals • Support knowledge transfer to Training Leads and disseminate new payer/process updates • Conduct administrative, concurrent utilization, and retrospective reviews via live, voicemail, fax, and portal reviews • Coordinate peer reviews as needed • Provide Assignment of Responsibility form templates at admission when required • Enter utilization review authorization information into facility EMR billing systems and internal workflow systems • Follow up on pending authorizations to secure approvals and documentation • Document and track utilization review activities in Salesforce and designated systems • Assist with document retrieval from EMRs • Act as liaison between facilities and internal teams • Send morning and end-of-day facility status updates and weekly stakeholder summaries • Maintain understanding of levels of care, insurance authorization requirements, and behavioral health regulations • Identify documentation gaps affecting authorization approvals • Review clinical documentation from a licensed nursing perspective and communicate charting deficiencies to facilities • Serve as clinical resource for escalations and complex case reviews • Ensure authorization requests comply with policies and payer requirements • Perform additional utilization review and prior authorization duties as assigned

🎯 Requirements

• Active and unrestricted Licensed Practical Nurse (LPN) credential • Minimum of 2 years of Behavioral Health Clinical, Utilization Review, case management, or prior authorization experience preferred • Knowledge of insurance authorization processes, levels of care, and medical necessity criteria • Excellent verbal and written communication for facility interactions • High level of accuracy and strong organizational, follow-up, and documentation skills • Proficiency in EMR systems, Salesforce, and other workflow platforms • Ability to prioritize tasks and manage multiple authorization cases simultaneously