Job Description
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Position: Remote Case Management Analyst (LPN/LVN) Duration: 6 + months (Possible Extension) Schedule: Monday - Friday, 8-5pm CST or EST Description: • LPN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. • Workers will be remote but should be located in TN, IL, TX, OK, NM or MT. This position is responsible for pre-authorization reviews in accordance with the medical contract and regulations, medical criteria, utilization review, and quality of care. Job Requirements: • LPN with valid, current, unrestricted clinical license in the state of operations. • Clinical experience in Home Health and DME • Utilization review or utilization management experience • Clinic Review for medical necessity based on specific needs of the patient and evidence supporting it and appropriateness of services. • Clinical Reviewer with relevant expertise and Medicare UM experiences responsible for making determinations utilizing the correct criteria and consider the clinical information provided. • Customer service oriented to assist internal/external customers. • Verbal and written communication skills. • Interpersonal skills and ability to be a team player. • Familiar with PC or database systems. • Incumbents with nursing licenses in positions/departments requiring multi-state licenses or compact licensure within your residential state. • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies. Maintain complete confidentiality of company business. • Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested. • Maintain production requirements based on established department business needs. EEO: “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.” Apply tot his job
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