LPN - Utilization Management Specialist (Hybrid)

Guidewell, Inc.; Florida; Hybrid; USD 34,000 - 56,000; Full time

Benefits offered by this job

Health insurance

Retirement plan

Paid time off

Life insurance

Job summary

Guidewell, Inc. is seeking an Administrative Nurse, LPN to support Clinical Review and Utilization Management activities in a hybrid Florida-based role.

The position focuses on member care while aligning with NCQA UM standards and involves medical review, authorization management, and referral creation. The ideal candidate has 3+ years of related experience, Florida LPN licensure, and strong communication skills with proficiency in Microsoft Office and multi-system navigation.

Qualifications

• 3+ years related work experience in Clinical, Managed Care, Home Health, Discharge Planning, Utilization Management.
• LPN - Licensed Practical Nurse - State of Florida Licensure.
• Excellent written and verbal communication skills; ability to navigate multiple screens and use Microsoft Office.
• Travel to corporate or regional office may be required.

Responsibilities

• Process authorization and medical review requests and generate denial letters and communications.
• Request additional information necessary for processing requests via phone, fax or letter.
• Verify benefits and determine provider participation; liaise with Network and Plan to Plan.
• Summarize incomplete information for medical director review and decisions.
• Census/Inventory Management, including duplicates and corrections of dates.
• Create authorization requests and referrals to case management and care partners.

Skills

LPN Florida Licensure

Communication skills

Microsoft Office

Multi-screen navigation

Education

High school diploma or GED

Tools

Jiva

Job description

Guidewell, Inc. is seeking an Administrative Nurse, LPN to support Clinical Review and Utilization Management activities in a hybrid Florida-based role.

The position focuses on member care while aligning with NCQA UM standards and involves medical review, authorization management, and referral creation. The ideal candidate has 3+ years of related experience, Florida LPN licensure, and strong communication skills with proficiency in Microsoft Office and multi-system navigation.