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

Moonpig

Machinist I Job at Moonpig

 ...Description The Machinist is responsible for setting up, operating, and maintaining a variety of machine tools to produce precision parts and instruments. This role requires strong technical skills, attention to detail, and the ability to read and interpret technical... 

Department of Developmental Services - Canyon Springs Commun...

Police Officer Job at Department of Developmental Services - Canyon Springs Commun...

 ..., and we are hiring multiple, highly motivated, and empathetic Police Officers to perform law enforcement activities necessary to ensure...  ...must complete a notarized waiver for access to their personal records. Required: POST Basic Academy certificate must be... 

RSI Security

HR and Operations Manager Job at RSI Security

 ...WE ARE HIRING HR and Operations Manager Position Details Reports to: Managing Director / Visionary Type: Full-time W-2...  ...Assistant, supporting a blended workforce of full-time employees, offshore contractors, and U.S.-based consultants under agreement. You... 

Plato's Closet: Nashville, Cool Springs and Murfreesboro TN

(Brentwood) Junior Stylist - Age 14 & 15 Job at Plato's Closet: Nashville, Cool Springs and Murfreesboro TN

 ...NOW HIRING 14 AND 15 YEAR OLDS! We are looking for an enthusiastic and hard-working Junior Stylist! Plato's Closet is excited to welcome young teens our team. We recognize that we need people of all ages to make our store awesome. Plus, getting your feedback on current... 

Annapurna Labs (U.S.) Inc.

Sr. Physical Design Engineer, Annapurna Labs Job at Annapurna Labs (U.S.) Inc.

 ...Machine Learning Acceleration team youll be responsible for the design and optimization of hardware in our data centers including...  ...of emergent technologies. Were looking for an ASIC Physical Design Engineer to help us trail-blaze new technologies and architectures,...