PACE UTILIZATION COORDINATOR - LVN

Job Description

Job Description

Position Summary

The PACE Utilization Coordinator - LVN supports utilization management functions for PACE participants. The position assists with utilization review activities, ensures accurate and timely authorizations, and supports care coordination efforts to deliver quality, cost-effective services. This role works under the supervision of the PACE Medical Director and collaborates with the clinical team and external providers.

Essential Duties and Responsibilities

• Assist in conducting concurrent and retrospective utilization management reviews.
• Support the review of hospitalizations, post-acute care stays, and specialty referrals.
• Track and process referral authorizations within required timeframes.
• Assist with discharge planning and communication with hospitals, skilled nursing facilities, and providers.
• Maintain accurate documentation of utilization management activities in the electronic medical record.
• Provide utilization data and reporting support to leadership and clinical teams.
• Identify and report potential utilization issues and outliers to the Medical Director.
• Serve as a liaison with providers and care managers for service authorization questions.
• Support the denial management and provider appeal process.
• Participate in interdisciplinary team meetings and care coordination discussions.
• Support quality improvement initiatives related to utilization management.
• Maintain current knowledge of PACE utilization requirements, policies, and procedures.
• Assist in identifying high-risk participants and escalating care concerns to medical leadership.

Minimum Qualifications

Preferred Qualifications

Physical Demands and Work Environment

Direct Reports

PACE Medical Director