Utilization Review - LPN or Social Worker - Kentucky License (Remote) Job at Morgan Stephens, Remote

RTdpWUNRR0ZJMllVeUdQeHpZeThlbmRr
  • Morgan Stephens
  • Remote

Job Description

Utilization Review LPN / Social Worker
Location: Remote - Must have Kentucky License
Job Type: Temp-to-Perm
Pay Rate: $36-38/hr

Job Summary:

A leading managed care organization is seeking a Utilization Review LPN or Social Worker to conduct utilization management (UM) reviews, ensuring appropriate medical services are provided in accordance with department policies and procedures. The ideal candidate will have a Kentucky (KY) licensure as an RN, LPN, or Social Worker and experience in utilization management, medical review, or related fields.

Key Responsibilities:

  • Conduct utilization management reviews using the medical management system, following departmental policies and procedures.
  • Review medical necessity, appropriateness, and efficiency of healthcare services based on clinical guidelines.
  • Collaborate with healthcare providers and members to ensure quality care and appropriate service utilization.
  • Communicate effectively with internal teams and external providers regarding authorization decisions.
  • Identify and escalate cases requiring additional medical review or intervention.
  • Maintain thorough and accurate documentation of all UM activities.
  • Ensure compliance with regulatory and accreditation standards.

Requirements:

  • Must have an active Kentucky (KY) license as an RN, LPN, or Social Worker.
  • Previous experience in utilization management, case management, or medical review preferred.
  • Strong understanding of medical terminology, clinical guidelines, and healthcare regulations.
  • Excellent communication and decision-making skills.
  • Proficiency with electronic medical management systems and documentation.

Work Schedule:

  • Flexible schedule between 8:00 AM – 5:30 PM EST (varied shifts available).
  • No strict time zone requirements—candidates in other time zones will be accommodated.

Why Join Us?

  • Competitive hourly pay with potential for permanent placement.
  • Opportunity to work remotely with a flexible schedule.
  • Gain experience in a growing healthcare sector with a reputable managed care organization.

If you meet the qualifications and are interested in this opportunity, apply today!

Job Tags

Hourly pay, Permanent employment, Temporary work, Flexible hours, Shift work,

Similar Jobs

Randstad Technologies

UX Writer/Content Strategist Job at Randstad Technologies

 ...type: Contract salary: $55 - 56 per hour work hours: 8am to 5pm education: Bachelors Responsibilities Write and edit UX copy for web and mobile experiences, including navigation, user flows, and transactional content. Translate complex financial concepts... 

Royal Caribbean Group

Pastry Cook - Rci Job at Royal Caribbean Group

 ...charge of producing the wide variety of delights available to our guest onboard our ships; items include: sweets cold and frozen, ice creams, ice cakes, pudding, chocolates, and more! Advanced pastry cooking methods, knowledge of mix techniques, and experience in a high... 

AIG

Financial, Planning & Analysis Senior Analyst - Finance Operations Job at AIG

Who we are American International Group, Inc. (AIG) is a leading global insurance organization. AIG member companies provide a wide range of property casualty insurance in approximately 70 countries and jurisdictions. These diverse offerings include products and ...

Mangrum Career Solutions LLC

Commercial Title Insurance Underwriting Counsel Attorney - Hybrid (Miami) Job at Mangrum Career Solutions LLC

 ...transactions. This role is ideal for a commercial real estate attorney or experienced title insurance underwriter who enjoys applying legal analysis to real estate matters, solving problems in real time, and partnering with internal teams and clients to deliver best-in-... 

Assurity Transportation Solutions

CDL A Owner Operator Semi Local Job at Assurity Transportation Solutions

 ...Local Some self dispatch accounts No trailer fees, mostly power only Most loads pay next day, no pay hold back...  ...an Amazing year. The sky's the limit! Semi Local CDL A owner operator Position with great pay and equitable home time for work/life...