Utilization Management LPN

Job Title: Utilization Management LPN
Allmed Benefits: Vision Insurance, Health Insurance, Dental Insurance and 401(k)
Pay Rate: $40/hr (Paid Weekly)
Work Location: 11511 SHADOW CREEK Pkwy, Pearland, TX
Contract: 05/11/2026 to 08/07/2026
Schedule: Monday – Friday, 8:00 AM – 5:00 PM

Position Overview:

The Utilization Management LPN supports daily utilization management operations by reviewing authorization requests, ensuring timely and accurate processing, and maintaining compliance with health plan and regulatory requirements. This role is essential in supporting workflow efficiency, particularly during periods of increased volume or team coverage needs.

Team Environment:

This position reports to a supervisor and works within a collaborative team of approximately 10–11 members. The team includes licensed nurses and utilization management professionals dedicated to meeting service level agreements, productivity goals, and quality standards in a fast-paced environment.

Key Responsibilities:

• Review and process authorization requests, including consults, follow-up visits, and procedures
• Apply medical necessity criteria such as InterQual and evaluate plan benefits
• Ensure accurate and timely documentation within EPIC or similar systems
• Communicate authorization decisions and status updates to providers verbally and in writing
• Maintain compliance with regulatory, quality, and audit requirements
• Support high-volume work queues and assist with coverage needs
• Coordinate redirection of services, benefit clarification, and continuity of care
• Meet established productivity, turnaround time, and quality benchmarks
• Assist with workflow improvements and departmental goals as needed

Qualifications:

Required:

• Active LVN/LPN license in a Compact State or Texas
• Minimum 2 years of clinical experience, preferably in utilization management or managed care
• Strong knowledge of medical terminology and clinical workflows
• Experience applying medical necessity criteria such as InterQual
• Excellent communication, documentation, and organizational skills
• Ability to multitask, prioritize workload, and meet deadlines

Preferred:

• Previous Utilization Management or Prior Authorization experience
• Experience with EPIC and/or IQ Cloud systems
• Knowledge of Medicare Advantage and Commercial plan requirements
• Strong understanding of compliance, audits, and regulatory processes
• Ability to work independently in a remote environment

Additional Information:

• License Required: Yes – Active LVN/LPN (Compact State or Texas)
• Dress Code: Business casual (remote-appropriate)
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