LPN-Quality & Utilization Management Coordinator

LPN-Quality & Utilization Management Coordinator Help improve healthcare quality and member outcomes. PrimeWest Health is seeking a collaborative and detail-oriented Quality & Utilization Management Coordinator to support our Quality & Utilization Management team. In this role, you'll play an integral part in utilization management, appeals and grievances, regulatory compliance, and care coordination while partnering with medical directors and interdisciplinary teams to ensure members receive the right care at the right time. What You'll Do Process and review service authorization requests and maintain accurate documentation in the care management system. Coordinate utilization management activities, including correspondence, medical record requests, audits, and reporting. Manage Appeals & Grievances from intake through resolution, ensuring compliance with regulatory timelines and documentation requirements. Review medical records, apply clinical criteria, provide coverage recommendations, and support grievance investigations. Monitor work queues and reports to ensure timely processing and regulatory compliance. Collaborate with providers, medical directors, and internal teams to promote quality care and exceptional member service. Participate in an on-call rotation for urgent utilization management and appeals requests. What You'll Bring Current, unrestricted Minnesota LPN license . Minimum 2 years of nursing experience in medical-surgical, home health, skilled nursing, or quality improvement. Experience in utilization management, utilization review, or appeals and grievances is preferred. Strong organizational, analytical, and communication skills with exceptional attention to detail. Proficiency in Microsoft Office and the ability to manage multiple priorities in a fast-paced environment. Knowledge of healthcare regulations, InterQual® criteria, CMS, DHS, NCQA, and managed care processes is a plus. Why You'll Love Working Here We value our employees and offer a comprehensive benefits package, including: Medical Insurance Dental Insurance Vision Materials Coverage Long-Term Disability (LTD) Coverage Life Insurance Pension Plan (PERA) 13 Paid Holidays Vacation Bank Sick Leave Bank Paid Volunteer Hours Fitness Center Onsite If you're passionate about quality healthcare, regulatory excellence, and making a meaningful impact for members, we'd love to have you join our team. Apply today!