Utilization Management LVN (Remote)

BroadPath provides transformational outsourcing and managed services powered by our one-of-a-kind, 100% remote business model. We provide highly flexible, scalable, and on-demand solutions that deliver unparalleled results. BroadPath’s fresh approach brings high-performance solutions to both seasonal or episodic work as well as steady-state operations. Healthcare, financial service, travel + hospitality, and high-growth companies leverage our remote workplace platform, Bhive, which makes remote work less distant and revolutionizes employee engagement, team performance and security in contact centers nationwide. Coupling BroadPath and Bhive introduces a better way. A better way of working, achieving results, connecting teams, and adapting to change. We live in the future – now. To take the journey with us and visit www.broad-path.com and www.go.inbhive.com

Utilization Management LVN (Remote) We're hiring a Licensed Vocational Nurse (LVN) to support our Utilization Management (UM) team in a fully remote role. This position plays a key part in conducting medical necessity reviews, coordinating authorizations, and ensuring appropriate utilization of healthcare services in line with established clinical guidelines. If you have strong clinical judgment, a sharp eye for detail, and thrive in a collaborative environment, we’d love to hear from you.

Conduct prospective, concurrent, and retrospective reviews to assess medical necessity and appropriateness of care Apply MCG or InterQual criteria to clinical documentation Process prior authorization requests and determine appropriate levels of care Collaborate with RNs, physicians, and other clinical staff to support timely and accurate reviews Communicate determinations to providers and members in a clear, professional manner Maintain accurate documentation of reviews, decisions, and communication in the system Escalate cases that do not meet guidelines to appropriate reviewers Ensure compliance with regulatory and accreditation requirements (NCQA, CMS, and state-specific guidelines) Participate in team meetings, trainings, and quality audits Support other projects or initiatives as needed