Job Description
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.”
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