Medical Case Manager LVN - Concurrent Review
Medical Case Manager LVN - Concurrent Review
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1-3years
$ $ 1000 - 5000
1 Vacancy
Job Description
Company Overview: Our client is a leading healthcare located in Orange CA seeking a medical case manager for Concurrent Review with an Licensed Medical Nurse (LVN) background.
Position Summary: The successful candidate should hold a current unrestricted LVN license with 3 years of nursing experience 1 year as a Clinical Nurse Reviewer along with 1 year of utilization management/prior authorization review experience.
Work Duration: up to 6 months
Work Schedule: Thursday Monday
Work type: Onsite with a possibility to Telework
Position Responsibilities:
- Review requests for medical appropriateness using established clinical protocols.
- Verify and process specialty referrals diagnostic testing outpatient procedures home health care services and durable medical equipment via telephone or fax.
- Screen requests for review by the Medical Director gather necessary medical information communicate decisions and document outcomes in the utilization management system.
- Ensure accurate coding (ICD10 CPT4 HCPCS) and coverage verification specific to Health s line of business.
- Address health network enrollments and liaise with Customer Service regarding networkrelated issues.
- Identify and report complaints to supervisors and escalate over/under utilization cases to the Medical Director.
- Maintain productivity and quality standards consistently.
- Complete additional assignments and projects as assigned.
- Assist in identifying staff training needs and maintain updated data resources.
Requirements
Experience & Education:
- Current unrestricted Licensed Vocational Nurse (LVN) license to practice in California.
- High School diploma or equivalent required.
- 3 years of nursing experience including 1 year as a Clinical Nurse Reviewer
- 1 year of Concurrent Review (inpatient) experience required
Necessary Attributes:
- Establish effective relationships with internal and external stakeholders.
- Demonstrate independent judgment and decisionmaking skills.
- Communicate effectively both verbally and in writing.
- Flexible schedule availability for evening and weekend events.
- Strong organizational analytical and problemsolving abilities.
- Proficiency in Microsoft Office (Word Outlook Excel PowerPoint) and jobspecific applications/systems
Benefits
Criteria: - BSN/Diploma in Nursing -At least 2 years Experience - Medical License
Education
Criteria: - BSN/Diploma in Nursing -At least 2 years Experience - Medical License
Employment Type
Full Time
