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Utilization Mgmt LVN in Houston, TX for Harris Health System
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Utilization Mgmt LVN
JOB SUMMARY: Manages Requests for Outside Services. Applies Screening Criteria for Harris Health eligible patients. Secures authorization for third party payers by providing pertinent clinical documentation according to payer guidelines. Communicates with clinic staff regarding insurance denials and impending insurance authorization expirations. Facilitates peer to peer review between the clinical staff and the payer for denied cases. Enters authorization information into EPIC Telephone Encounters. Schedule patients for outsourced procedures. Follows up with test results and ensure placement in EPIC for physician retrieval. Strong written and verbal skills are necessary in order to communicate with clinical staff and payers. MINIMUM QUALIFICATIONS: Edu


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