LPN Utilization Management
New
H
HealthCare StrategiesHealthcare Management
United States, Daytime business hours, 10a-5:30pPart-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- Minimum of one (1) year
- Required Skills
- EHRHIPAAData entry
Requirements
- Active, unrestricted Compact Licensed Practical Nurse (LPN) license.
- Minimum of one (1) year of recent direct patient care experience in a hospital or acute care setting.
- Strong clinical assessment and critical thinking skills.
- Excellent verbal and written communication skills.
- Strong organizational and time management abilities.
- Ability to work independently in a remote environment.
- Basic computer skills, including Microsoft Outlook and data entry.
- Dedicated home office or quiet workspace.
- Reliable high-speed internet with minimum speeds of 25 Mbps download and 25 Mbps upload.
Responsibilities
- Receive and review requests for medical services to obtain necessary clinical information.
- Apply evidence-based clinical criteria to support initial review determinations.
- Refer cases not meeting clinical criteria to supervisory staff or physician reviewers.
- Identify and generate referrals for Case Management or HealthReach services.
- Document clinical reviews, communications, and member information in the electronic system.
- Prepare and transmit authorizations within required timeframes.
- Manage incoming telephone calls, triage requests, and provide customer service to providers and members.
- Explain benefit plan requirements and maintain confidentiality of protected health information.
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