LPN: Utilization Management Reviewer

ebnhc; Boston (MA); On-site; USD 45,000 - 66,000; Full time

Job summary

NeighborHealth in Boston is seeking an experienced LPN UM Reviewer to support the Utilization Management team. You will review authorization requests, apply medical necessity criteria, coordinate care with providers, and ensure regulatory compliance.

The role requires an LPN license, familiarity with managed care, and strong documentation, communication, and computer skills. This full-time position is based at 10 Gove Street, Taylor Building, with competitive hourly pay based on experience.

Qualifications

• Current, unrestricted LPN license.
• Experience in managed care, utilization management, or clinical review preferred.
• Knowledge of medical terminology, healthcare regulations, and clinical documentation.
• Strong organizational, communication, and computer skills.

Responsibilities

• Review prior authorization requests for medical services, medications, DME, home health, and other healthcare services.
• Apply established clinical guidelines and medical necessity criteria when evaluating requests.
• Gather and review clinical documentation from providers and facilities.
• Communicate with providers, care managers, and interdisciplinary team members regarding authorization decisions and required documentation.
• Escalate complex cases or requests that require RN or Medical Director review.
• Document determinations and activities accurately in utilization management systems.
• Monitor authorization turnaround times and regulatory compliance requirements.
• Support appeals, reconsiderations, and grievance processes as assigned.
• Participate in quality improvement and audit activities.

Skills

LPN license

Organizational skills

Communication skills

Computer skills

Education

LPN license

Tools

EMR systems

Authorization management systems

Job description

NeighborHealth in Boston is seeking an experienced LPN UM Reviewer to support the Utilization Management team. You will review authorization requests, apply medical necessity criteria, coordinate care with providers, and ensure regulatory compliance.

The role requires an LPN license, familiarity with managed care, and strong documentation, communication, and computer skills. This full-time position is based at 10 Gove Street, Taylor Building, with competitive hourly pay based on experience.