Utilization Management LVN

WelbeHealth is transforming senior care by providing an all-inclusive healthcare option for vulnerable seniors. The Utilization Management LVN is responsible for auditing authorization requests and ensuring compliance with medical guidelines to provide timely and quality care. Responsibilities Chart audits of items including but not limited to consult summaries, imaging results, and procedure summaries to determine if additional follow up services are requested Oversee departmental clinical inboxes, email inboxes, and fax queues to ensure appropriate handling of documents and authorization requests Identify, document, and correct inconsistencies and gaps in participants’ charts with authorizations in the UM system Review prior authorization requests for medical necessity and alignment with participants’ care plans, including routine office visits, procedures, and DME Skills Minimum of one (1) year of chart auditing or UM review experience Knowledgeable in areas of Medicare and Medicaid UM regulations Unencumbered LVN licensure Benefits Medical insurance coverage (Medical, Dental, Vision) starting day one of employment Work/life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days Advancement opportunities - We’ve got a track record of hiring and promoting from within, meaning you can create your own path! 401(k) match Comprehensive healthcare coverage A broad range of additional benefits Company Overview Unlocking the full potential of our most vulnerable seniors with empathy and love. It was founded in 2015, and is headquartered in Menlo Park, California, USA, with a workforce of 501-1000 employees. Its website is Company H1B Sponsorship WelbeHealth has a track record of offering H1B sponsorships, with 1 in 2025, 1 in 2024, 2 in 2023, 1 in 2022, 2 in 2021. Please note that this does not guarantee sponsorship for this specific role.