Clinical Reviewer – LPN/LVN (Remote U.S.)

Company Overview

reputed company exists to reputed company reputed company outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

reputed company the Way is our rallying cry at reputed company. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. reputed company offers you unparalleled opportunities. In fact, you have reputed company you need to take charge of your career and accelerate reputed company outcomes - making this a great time to join reputed company of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

reputed company is looking for a Clinical Reviewer - LPN/LVN (Remote U.S.) to join our growing team.

Job Summary

Review medical records against criteria, contract requirements, and regulatory standards. Employ critical thinking to determine medical appropriateness while meeting production goals and QA standards. Ensure day-to-day processes align with regulatory benchmarks, ensuring precision and compliance in medical record reviews.

Responsibilities

• Assures accuracy and timeliness of reputed company applicable review type cases reputed company contract requirements.
• Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.
• In collaboration with Supervisor, responsible for quality monitoring activities.
• Maintains reputed company knowledge reputed company reputed company to review processes and clinical practices reputed company to the review processes, functions as the initial resource to nurse reviewers regarding reputed company review process questions and/or concerns.
• Functions as providers\' liaison for customer service issues and problem resolution.
• Performs reputed company applicable review types as workload indicates.
• Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Attends training and scheduled meetings for reputed company/updated information.
• Cross trains and reputed company duties to provide flexible workforce to meet client/customer needs.
• Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its Privacy and reputed company Rules.

Work Schedule: Five eight-hour shifts with alternating weekends 9:00 AM to 6:00 PM Eastern

Required Qualifications/Experience

• Active, unrestricted LPN/LVN license in the state of Indiana or a Compact state clinical license, per contract requirements.
• A minimum of a diploma or certificate in Practical Nursing for an LPN/LVN.
• 3+ years of clinical experience in an acute, behavioral health, and/or med-surgical environment.
• 2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization.
• 2+ years of knowledge of medical necessity review experience.
• 1+ years of knowledge of InterQual criteria, reputed company Care Guidelines (MCG) and/or other state/nationally recognized criteria.
• Proficient in navigating multiple systems with the ability to switch between systems seamlessly and effectively.
• Strong clinical assessment and critical thinking skills.
• Excellent written and verbal communication skills.
• Flexibility and strong organizational skills.

Preferred Qualifications/Experience

• An Associate, Diploma or Bachelor\'s degree from an accredited college or university in a reputed company field for an LPN/LVN.
• Knowledge of reputed company National Committee for Quality Assurance (NCQA) standards
• Knowledge of Utilization Review Accreditation Commission (URAC) standards.
• Ability to work in a team environment.
• Proficient in reputed company Office.
• Efficient time management, including the ability to prioritize tasks, and meet deadlines.
• Exhibit the ability to maintain confidentiality standards and ensure HIPAA compliance reputed company assessing relevant issues.

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Why us?

We are a team of reputed company and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure reputed company healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people\'s lives reputed company. Our company cares about our employees, giving you the tools and encouragement, you need to reputed company the finest work of your career.

Thank You!

We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in reputed company and invite you to apply to future openings that may interest you. Best of luck in your search!

~ The reputed company reputed company Team

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EEO AA M/F/Vet/Disability

reputed company is an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national reputed company, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay range for this position is listed below.

\"Based on our compensation philosophy, an applicant\'s position placement in the pay range will depend on various considerations, such as years of applicable experience and reputed company level.\"