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

Jon & Vinny's

Pastry Cook - Commissary Job at Jon & Vinny's

 ...are Join the team at Jon & Vinnys , where passion for great food and genuine hospitality come together in a fast-paced, energetic...  ...standards for food quality control to uphold Food Safety Standards Good communication with the packers and chefs on daily needs... 

Interim HealthCare of East Tennessee

Medical Social Worker (MSW) / Licensed Clinical Social Worker (LCSW) Job at Interim HealthCare of East Tennessee

 ...members. * Responsible for assisting the physician and other health care team members in assessing and understanding the significant social and emotional needs related to the health problems of the patient/client. * Responsible for the provision of social work services... 

Regal Staffing Services

Machine Process Operator (DAL) Job at Regal Staffing Services

 ...Regal Staffing Services is hiring Machine Process Operators for a food and cosmetics manufacturing facility in Midlothian. This role involves operating, maintaining, and cleaning production equipment in a fast-paced environment. Pay: ~1st Shift: MondayFriday +... 

CIRCULUS ARAB, PBLLC

Process Operator Job at CIRCULUS ARAB, PBLLC

 ...The purpose of this job is to operate assigned equipment or areas of the plant and perform operations related activities per the work process, utilize process knowledge and experience to operate and troubleshoot the plant in a safe and efficient manner, work in a team... 

Blue Star Partners LLC

Pipeline Engineer (Contract) Job at Blue Star Partners LLC

 ...Job Title: Pipeline Engineer Location: Canonsburg, PA (Hybrid: Three times a week) Rate: $40 $60/hr (W2) Contract Duration: 6 Months Contract Type: W2 (Applicants must be authorized to work in the U.S.; no sponsorship available) Qualifications: ~ Bachelor...