Hybrid LPN: Utilization Management & Medical Review

Florida Blue Group; Florida; Hybrid; USD 34,000 - 44,000; Full time

Benefits offered by this job

Health insurance

Disability benefits

401k with employer match

Paid time off

Job summary

Florida Blue Group seeks an Administrative Nurse, LPN to support Clinical Review/Utilization Management processes, with a focus on member care. The role aligns with NCQA UM Accreditation standards and requires active Florida LPN licensure.

You will process authorizations, verify benefits, request information, and assist in care coordination while working in a hybrid schedule and collaborating with network partners.

Qualifications

• 3+ years related work experience in Clinical, Managed Care, Home Health, Discharge Planning, Utilization Management
• High school diploma or GED
• Excellent written and verbal communication skills; ability to navigate multiple screens/systems and using Microsoft Office
• Travel to corporate or regional office may be required for meetings and events

Responsibilities

• Process authorization and medical review requests including approvals/denials and denials letters
• Request additional information needed for processing; use Medical Coverage Guidelines/InterQual criteria
• Benefit verification of services (SNF, LTAC, IP Rehab); determine provider participation status
• Summarize incomplete submissions for medical director review and processing decisions
• Census/Inventory Management; correct authorization errors and duplicates
• Create authorization requests and referrals to case management or other care partners

Skills

Communication skills

Microsoft Office

Education

LPN - Licensed Practical Nurse (Florida licensure)

Job description

Florida Blue Group seeks an Administrative Nurse, LPN to support Clinical Review/Utilization Management processes, with a focus on member care. The role aligns with NCQA UM Accreditation standards and requires active Florida LPN licensure.

You will process authorizations, verify benefits, request information, and assist in care coordination while working in a hybrid schedule and collaborating with network partners.