Remote LPN Medical Reviewer I - Utilization Management Specialist
We are seeking a highly skilled and detail-oriented LPN Medical Reviewer I to join our team as a Utilization Management Specialist. As a key member of our medical review team, you will be responsible for performing medical reviews, utilization management, and appeals using established criteria sets and clinical guidelines. This is a full-time, remote opportunity after completing 6 months of on-site training, offering a unique chance to work from home and contribute to the delivery of high-quality healthcare services.
Key Responsibilities:
Perform medical reviews and make reasonable charge payment determinations
Monitor process timeliness and ensure compliance with contractor standards
Conduct authorization processes, ensuring coverage for appropriate medical services within benefit and medical necessity guidelines
Utilize allocated resources to back up review determinations and provide education to members and their families/caregivers
Participate in quality control activities and maintain accurate documentation of all determinations and basis for each
Requirements:
Bachelor's degree in Social Work or graduate of an accredited school of Licensed Practical Nursing or Licensed Vocational Nursing
2 years of clinical experience
Active, unrestricted LPN/LVN licensure from the United States and in the state of hire
Working knowledge of word processing software and good judgment, customer service, and organizational skills
Preferred Qualifications:
Associate Degree in Nursing or graduate of an accredited school of nursing
Working knowledge of spreadsheet and database software
Demonstrated oral and written communication skills and ability to persuade, negotiate, or influence others
What We Offer:
Comprehensive benefits package, including subsidized health plans, dental and vision coverage, 401k retirement savings plan, and life insurance
Paid Time Off (PTO) and education assistance
Opportunities for professional growth and development in a diverse and inclusive workplace
How to Apply:
If you are a motivated and detail-oriented individual with a passion for delivering high-quality healthcare services, please submit your application, including your resume and a cover letter, to be considered for this exciting opportunity.
Apply Now
Apply Now
Apply Now
Apply Now
Key Responsibilities:
Perform medical reviews and make reasonable charge payment determinations
Monitor process timeliness and ensure compliance with contractor standards
Conduct authorization processes, ensuring coverage for appropriate medical services within benefit and medical necessity guidelines
Utilize allocated resources to back up review determinations and provide education to members and their families/caregivers
Participate in quality control activities and maintain accurate documentation of all determinations and basis for each
Requirements:
Bachelor's degree in Social Work or graduate of an accredited school of Licensed Practical Nursing or Licensed Vocational Nursing
2 years of clinical experience
Active, unrestricted LPN/LVN licensure from the United States and in the state of hire
Working knowledge of word processing software and good judgment, customer service, and organizational skills
Preferred Qualifications:
Associate Degree in Nursing or graduate of an accredited school of nursing
Working knowledge of spreadsheet and database software
Demonstrated oral and written communication skills and ability to persuade, negotiate, or influence others
What We Offer:
Comprehensive benefits package, including subsidized health plans, dental and vision coverage, 401k retirement savings plan, and life insurance
Paid Time Off (PTO) and education assistance
Opportunities for professional growth and development in a diverse and inclusive workplace
How to Apply:
If you are a motivated and detail-oriented individual with a passion for delivering high-quality healthcare services, please submit your application, including your resume and a cover letter, to be considered for this exciting opportunity.
Apply Now
Apply Now
Apply Now
Apply Now