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Utilization Management Clinician LPN

Position Purpose: The Utilization Review (UM) Clinician (LPN) performs clinical reviews to assess medical necessity of a broad range of outpatient and inpatient services, while maintaining compliance with all regulatory requirements.
Interfaces with medical directors, and both internal and external stakeholders, with regard to coverage for services, contract benefits and alternate resources available.
This position interfaces frequently with treating providers in the gathering of clinical information and may also provide education on the medical review process.
The Utilization Management clinician (LPN) makes coverage decisions based on specific criteria including Milliman.
Frequently collaborates with Fidelis medical directors in determining coverage of requested services.
Interacts with members to assist with accessing appropriate resources for requested services.
Education/Experience: Associate's degree or equivalent required; Bachelors Degree preferred. 1-3 years Utilization Review experience preferred. Managed care experience preferred
License/Certification: NYS LPN License Required
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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