Utilization Analyst LPN

Roanoke, VA, US, 24011

Job Summary

Be at your best with an organization that equips you to do so.  Whose people unite in making lives better. At Carilion Clinic, we help communities stay healthy and our region grow stronger through compassionate care, medical education and research, and neighborhood outreach. As part of our team you can expect professional stability, strong technological resources, and the advancement potential of a regional leader.

As a member of the Care Management Team, performs utilization review functions that assist in the performance of case management, social services, and resource management. Consistently deliver the best in customer service and patient care.  As a team member, demonstrate respect, dignity, kindness and empathy in each encounter with patients, families, visitors and other employees.  Communicates with payers social workers, nursing staff, case managers, external organizations, patients, families, physicians and other services to coordinate resource management and reimbursement of services.

Job responsibilities include:

  • Keeps current with timelines, processing, and review criteria for multiple payers.  Serves as a contact and resource for all members of the case management team and physicians on specific payers (payer specific specialist).

  • Maintains knowledge of and compliance with changing State/Federal regulations impacting UR per departmental guidelines.  Educates healthcare team members, patients and families on regulations as needed.

  • Assists physicians in appropriate documentation to optimize patient’s benefits and medical record coding.

  • Performs admission and continued stay reviews in accordance with hospital policy and payer contract requirements to ensure appropriate reimbursement for services.  Researches and responds to requests for additional information and/or follows through with notification of involved areas if inaccuracies are identified.  

  • Coordinates information/data sharing across departments as directed. Facilitates compilation and retrieval of case records and accounts as needed for audits, surveys, performance improvement, compliance and billing.  Works with on site payer reviewers to ensure communication and collaboration of services.

  • Assures data entry and reporting of statistical and operational/service indicators within specified time frames.

  • Communicates with payers and refers issues to case manager, social worker, or physician, as necessary.

  • Facilitates Physician Peer to Peer medical reviews as needed.

  • Refers all potential/actual denials to Denial specialist for review and determination of appropriate appeal.

Make the most of your clinical skills at an organization that has earned numerous awards for clinical excellence. Our community-based healthcare network encompasses seven hospitals‐including a U.S. News & World Report Top 10 Hospital and two Magnet®-designated hospitals‐multi-specialty physician practices, and affiliations with prestigious academic medical institutions.

Based in Roanoke, VA, we are an award-winning, community-based network of hospitals, primary and specialty physician practices, and affiliations with prestigious academic medical institutions. Explore how joining a regional leader can enhance your ability to learn, grow, and succeed.


Minimum Qualifications

Education: Graduate of an accredited nursing school for practical nursing

Eperience:  3 years in a clinical setting providing direct patient care, or in Utilization Review

Licensure, certification, and/or registration:  Licensed to practice nursing LPN in the state of Virginia. Must obtain/maintain AHS BLS-HCP required.  May be required to obtain/maintain AHA BLS based on specific work unit.

Other Minimum Qualifications:  Knowledge of insurance and Interqual guidelines helpful.  Positive interpersonal oral communication skills; effective written communication skills; analytical skills; integrity; innovation; team player; courteous; ability to resolve complaints/problems;  service excellence philosophy of service delivery; ability; willingness to work as an integral member of a multi skilled team.

Our Values

Below are our core values that we strive to embody and expect of all our team members:

CommUNITY:  Working in unison to serve our community, our Carilion family and our loved ones.

Courage:  Doing what’s right for our patients without question.

Commitment:  Unwavering in our quest for exceptional quality and service.

Compassion:  Putting heart into everything we do.

Curiosity:  Fostering creativity and innovation in our pursuit of excellence.



Requisition Number: 11062 
Employment Status: Full time 
Location: CASB - Carilion Administrative Services Building 
Shift: Day 
Shift Details: Full-time, Mon - Fri, Some Flexibility w/ Schedule
Recruiter Phone: 540-983-4040 
Recruiter Email: MBWatts@carilionclinic.org 


As a not-for-profit organization, we pride ourselves on investing in our employees and the communities we serve. 

Our employees strive to provide quality care in serving over 1 million residents in Virginia while living and growing their careers in the country's most livable cities and towns. 

Headquartered in Roanoke, Va., Carilion Clinic is a robust system of small and large award-winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.

Equal Opportunity Employer
Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity

Carilion Clinic is a drug-free workplace.


Posting Notes:

Nearest Major Market: Roanoke

Job Segment: Neurology, LPN, Orthopedic, Nursing, Medical, Healthcare

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