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

Similar Jobs