• Review and process authorization requests (consults, follow-ups, procedures)
• Apply medical necessity criteria (e.g., InterQual) and benefit plans
• Ensure accurate and timely documentation within EPIC
• Communicate authorization decisions to providers (verbal and written)
• Maintain compliance with regulatory standards and audit requirements
• Manage high-volume workloads and support team coverage needs
• Assist with care coordination, redirection, and benefit clarification
• Meet established productivity and quality benchmarks

Required Qualifications

• Active LVN/LPN license (Compact State or Texas required)
• Minimum 2+ years of clinical experience (UM, managed care preferred)
• Strong knowledge of medical terminology and clinical workflows
• Experience applying medical necessity criteria (e.g., InterQual)
• Excellent documentation and communication skills
• Ability to manage multiple priorities and meet deadlines

Preferred Qualifications

• Prior experience in Utilization Management
• Familiarity with EPIC and/or IQ Cloud
• Experience with Medicare Advantage and Commercial plans
• Strong understanding of audit processes and compliance standards

Ability to work independently in a remote environment

By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively “Judge”) to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge's Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help.