- Kelsey-Seybold Clinic (Houston, TX)
- **Responsibilities** The Utilization Review Specialist ( LVN ) is responsible for conducting medical reviews, benefit verification, and applying criteria ... care services requiring authorization prior to services being rendered for members. The Utilization Review Specialist ( LVN ) serves as a liaison in… more
- STG International (Milledgeville, GA)
- …our Georgia War Veterans Home. JOB SUMMARY: The primary purpose of the lead LPN/ LVN is to provide direct nursing care to the residents. ESSENTIAL FUNCTIONS: + Ensure ... forms, reports, evaluations, studies, charting, etc., as necessary. + Periodically review the department's policies and procedures manuals, job descriptions, etc.,… more
- Cedars-Sinai (CA)
- …their needs, coordinating care, communicating with health plans, including concurrent review to determine the appropriateness of services rendered and to ensure ... to nurse practitioner and case manager assigned to the SNF's for continued review and follow up. + Authorizes all appropriate services based upon covered benefits… more
- Molina Healthcare (Tampa, FL)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more