Overview

The Utilization Management LVN (Licensed Vocational Nurse) supports the UM team by conducting medical necessity reviews, coordinating authorizations, and ensuring appropriate utilization of healthcare services in accordance with established guidelines. This role requires strong clinical judgment, attention to detail, and excellent communication skills to effectively collaborate with providers, members, and internal teams.

Responsibilities

• Conduct prospective, concurrent, and retrospective reviews to determine medical necessity and appropriateness of care
• Apply established criteria such as MCG or InterQual to assess clinical documentation
• Assist with processing prior authorization requests and determining level of care
• Collaborate with RNs, physicians, and other clinical staff to ensure coordinated, timely reviews
• Communicate determinations to providers and members in a timely and professional manner
• Maintain accurate documentation of clinical reviews, determinations, and communications in the system
• Identify and escalate cases that do not meet criteria to the appropriate clinical reviewer
• Ensure compliance with regulatory and accreditation standards including NCQA, CMS, and state-specific guidelines
• Participate in team meetings, trainings, and audits to ensure quality and consistency
• Support special projects or initiatives as assigned by leadership

Qualifications

• Active and unrestricted LVN license in an eNLC (Enhanced Nurse Licensure Compact) state with multistate privileges
• 3+ years of Nursing experience
• 1+ years of Utilization Management experience
• Familiarity with medical terminology, utilization management guidelines, and clinical documentation standards
• Proficiency in Microsoft Office and experience working with healthcare systems or electronic medical records
• Strong organizational and time management skills with the ability to work independently
• Excellent written and verbal communication skills

Disclosure:

At BroadPath, we believe that transparency, authenticity, and collaboration are the keys to building strong, connected remote teams. Being on camera is an integral part of our culture. It's how we build relationships, share ideas, and stay engaged. If you're someone who values open communication, connection, and teamwork, you'll thrive in our environment where showing up authentically matters.

What to Expect:

• On-camera participation during interviews, training, team meetings, and regular check-ins.
• Face-to-face discussions sparking collaboration and engagement
• A supportive atmosphere where you can express yourself openly and be part of a team that values your contributions.

BroadPath may conduct background checks, previous employment verifications, and education verifications, based on position requirements

Diversity Statement

At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!

Equal Employment Opportunity/Disability/Veterans

If you need accommodation due to a disability, please email us at HR@Broad-path.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.

BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law.

Compensation: BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.