LVN Utilization Review Specialist - Kelsey Seybold Clinic: Remote

Overview

Explore opportunities with Kelsey‑Seybold Clinic, part of the Optum family of businesses. Work with one of the nation’s leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi‑specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties.

Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to determine medical necessity for health care services requiring authorization prior to rendering services to members. They serve as a liaison reviewing requests for medical and surgical procedures, services and admissions, and communicate with providers regarding pertinent information needed for medical review to ensure service decisions are determined within appropriate time frames.

The role also supports Medicare Advantage appeals, handles denial letters in accordance with Texas Department of Insurance and CMS, serves as liaison and primary point of contact for add‑on procedures at the KS Ambulatory Surgery Center, and supports utilization review quality assurance initiatives, including mock audits, to ensure compliance. The position requires flexibility and adaptation to changes in policies and procedures to meet evolving business needs.

• Licensed Vocational Nurse.
• CEU requirements must be maintained.
• TX LVN license.
• 5+ years of utilization review experience at a health plan, ACO, IPA, or provider group.
• HMO, PPO, and POS insurance knowledge.
• Valid driver’s license.

• Certification in area of specialization.
• Bilingual.
• Experience working with insurance (HMO, PPO, and POS) companies to obtain authorizations and pre‑certification for medical services.
• Consistent and prompt attendance at employer worksite is an essential job requirement.
• Excellent verbal and communication skills, and organizational skills.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. The hourly pay ranges from $20.00 to $35.72 per hour based on full‑time employment. We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution subject to eligibility requirements. All employees working remotely will be required to adhere to United Health Group’s Telecommuter Policy.

Optum Care is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. Optum Care is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.