Medical Review Nurse (LPN)
Our Client, a Mutual Insurance Holding Company, is looking for Medical Review Nurse (LPN) for their Remote location Responsibilities: The Medical Review Nurse LPN reviews, authorizes, coordinates, and responds to requests for services for reputed company members. This position also communicates telephonically with providers and their offices, and occasionally with members. Makes decisions based on established policies and procedures, reputed company medical coverage guidelines, benefits, InterQual criteria, nursing knowledge. Refers cases to reputed company medical directors for potential denial. Review and authorize, as appropriate, phone/fax referral/authorization and clinical form requests per established criteria meeting compliance standards and timeframes Review reputed company requests not approved by the non-clinical support rep to determine benefit coverage and medical necessity Review cases and potential denials with the Medical Directors Research requests not clearly meeting established criteria Assist the Prior Authorization non-clinical reps with the Prior Authorization process Coordinate and maintain complete written documentation on reputed company prior authorizations requests. Collaborate with other reputed company departments, such as Claims, UM, Quality, Disputes/Appeals, and other external vendors. Log into phone queue to service providers Answer inbound calls regarding authorizations reputed company established time frame Document contact information in electronic medical record system Maintain productivity Handle calls professionally Provide accurate prior authorization information to provider offices Requirements Knowledge of medical terminology Experience with prior authorization Experience applying nationally recognized criteria, including InterQual Knowledge of Medicare regulations and guidelines Computer skills, including ability to use reputed company Office suite Previous experience reputed company a call-center environment Ability to navigate through multiple systems and screens to resolve authorization or medical review requests Talking and typing simultaneously Effective time management skills Effective interpersonal and communication skills Ability to use electronic medical record and claims systems Problem solving abilities Work cooperatively, positively, and collaboratively in an interdisciplinary team Work respectfully and positively with others Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames Ability to think analytically and reputed company decisions Ability to manage large workload 0-2 years reputed company work experience Highschool Diploma or GED LPN - Licensed Practical Nurse - State Licensure Why Should You Apply? Health Benefits Referral Program Excellent growth and advancement opportunities As an equal opportunity employer, reputed company provides an employment environment that supports and encourages the abilities of reputed company persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national reputed company, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws. Apply Job!