Remote LVN: Utilization Management & Care Coordination

Harbor Health; Austin (TX); Remote; USD 60,000 - 80,000; Full time

Benefits offered by this job

Competitive salary

Comprehensive benefits

Job summary

Harbor Health is seeking a dedicated Utilization Management (UM) LVN to support prior authorization and utilization review activities, ensuring timely access to care. This fully remote role collaborates with providers, members, and the UM team to facilitate determinations and regulatory compliance.

The position requires an LVN license and 2–3 years of clinical experience, with familiarity in CPT codes, NCQA processes, and UM platforms.

Qualifications

• Current, unrestricted LVN license.
• Minimum of 2–3 years of clinical experience; prior UM/Case Management preferred.
• Knowledge of TX social service programs; NCQA familiarity helpful.
• Knowledge of CPT codes and prior authorization requirements.
• Experience with utilization review processes and medical necessity determinations.
• Strong organizational and communication skills; ability to work independently and in a team.

Responsibilities

• Coordinate and manage prior authorization workflows with the UM team.
• Monitor authorization requests via fax/phone and enter cases into tracking system.
• Review clinical docs and CPT codes to determine prior authorization needs.
• Submit cases to UR vendor for medical necessity determinations.
• Maintain case documentation and track status to meet regulatory timelines.
• Draft and send notification letters to providers and members.
• Coordinate concurrent documentation from hospitals and post-acute facilities.
• Communicate missing information to expedite review and authorization.
• Support high-need/high-cost members with ongoing communication and care coordination.
• Assist with transitions of care and post-discharge coordination as applicable.

Skills

Organizational skills

Workflow management

Communication skills

Google Workspace

EHR systems

Electronic UM platforms

Multitasking

Education

Licensed Vocational Nurse (LVN) license

Tools

EHR systems

UM platforms

Google Workspace

Job description

Harbor Health is seeking a dedicated Utilization Management (UM) LVN to support prior authorization and utilization review activities, ensuring timely access to care. This fully remote role collaborates with providers, members, and the UM team to facilitate determinations and regulatory compliance.

The position requires an LVN license and 2–3 years of clinical experience, with familiarity in CPT codes, NCQA processes, and UM platforms.