LPN Utilization Management Nurse (Hybrid)

GuideWell; Florida; Hybrid; USD 34,000 - 56,000; Full time

Benefits offered by this job

Hybrid work arrangement

Competitive pay

Paid time off

Retirement plan with employer match

Health insurance

Job summary

GuideWell is seeking an Administrative Nurse, LPN to support Clinical Review/Utilization Management processes in pre-service, concurrent, and post-service review. The role emphasizes member care within NCQA UM standards and requires Florida LPN licensure and 3+ years in relevant fields.

You will process authorizations, request information, verify benefits, and prepare summaries for medical director decisions. A hybrid in-office arrangement and strong communication skills are valued.

Qualifications

• 3+ years related work experience in Clinical, Managed Care, Home Health, Discharge Planning, Utilization Management
• High school diploma or GED required
• LPN license for Florida required
• Excellent written and verbal communication skills; ability to navigate multiple screens/systems

Responsibilities

• Process authorization and medical review requests including denials and notification letters
• Request additional information per guidelines to support reviews
• Verify benefits and determine provider participation; coordinate with Network/Plan
• Summarize missing information for medical director review and decisions
• Manage census/inventory to correct errors and update dates
• Create authorization requests and referrals to case management and care partners

Skills

Communication skills

Multi-screen navigation

Microsoft Office

Education

High school diploma or GED

LPN licensure (Florida)

Tools

Microsoft Office

Job description

GuideWell is seeking an Administrative Nurse, LPN to support Clinical Review/Utilization Management processes in pre-service, concurrent, and post-service review. The role emphasizes member care within NCQA UM standards and requires Florida LPN licensure and 3+ years in relevant fields.

You will process authorizations, request information, verify benefits, and prepare summaries for medical director decisions. A hybrid in-office arrangement and strong communication skills are valued.