Utilization Coordinator Lpn Jobs

Excellent time management, organization, research, analytical, negotiation and interpersonal skills

Assesses and evaluates cases and implements treatment and case management plans.

Develops an understanding of Epic's referral and scheduling capabilities, and available tools.

At least three years of clinical experience as a LPN/LVN in an ambulatory care, occupational health, or emergency department setting.

Be able to work in and create a positive attitude environment, manage caseload, complete task/duties and address conflicts as they arise.

Excellent problem-solving skills and ability to build positive relationships

Experience utilizing EMR or case management software

Effective management of electronic confirmation systems (i.e. eMessenger, Pega communicator, ACD) in order to minimize no show rates

Excellent data entry and typing skills

Ability to coordinate with regional utilization manager (RUM) on IPA utilization issues

Efficiently utilizes electronic tools and workflows in order to manage resources such as: ECW, UCM, eProcess and other tools as necessary

Excellent communication skills in English, both written and verbal

Starts at $30-31+ per hour based on experience, education, and certifications.

Possess one of the following certifications: (RN, DC, PT, DPT, LVN, OT, LAc).

1 year of clinical experience

Knowledgeable with computer programs (MS Word, MS Excel, Email) and toggling between multiple screens.

Medical, Dental & Vision Insurance

Paid Time Off & Paid Holidays

Process prospective, concurrent, retrospective Utilization Management (UM) medical requests and 1st level appeal, adhering to Fund’s established timeframes

Tro ubleshoot and interve ne with difficult vendors/providers and assist with urgent/expedited/complex cases that require management level problem solution.

Work closely with medical advisors and management team for escalated complex UM requests

Perform special projects and assignments as directed by management

Authorize vendor services based on skilled need and or medical necessity applying relevant

Working experience utilizing Milliman Care Guidelines

Interacts with management, physicians and field staff utilizing a teamwork approach

Responsible for assisting the Care Group Managers in the overall patient/family direct care function.

Current Basic Life Support Certification.

30 hour IV Certification preferred.

Use Your Nursing Skills To Make a Difference.

Current license to practice as a Licensed Practical Nurse in the State of Florida.

Experience in skilled nursing and/or assisted living facilities.

Completion of a professional nursing education program approved by the Minnesota Board of Nursing.

Current Certification in Cardiopulmonary Resuscitation (CPR) and emergency care or be willing to get one upon hire.

Current Minnesota License as a Practical Nurse.

This position is at our Villas at St. Paul location.

Education, Knowledge, Skills and Abilities Required

Education, Knowledge, Skills and Abilities Preferred

Strong planning and organizational skills with the ability to work independently, multi-task, and prioritize responsibilities.

Excellent written, verbal and telephone communication skills. Must be able to facilitate webinar meetings.

Effective and compassionate communication with patients and their significant others to plan, implement and follow up on gaps in care.

Frequent telephonic interactions with patients and their significant other to close gaps in care.

3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company.

Knowledge of medical terminology and procedures.

Verbal and written communication skills.

This position is Remote / Telecommute

We encourage people of all backgrounds and experiences to apply.

Registered Nurse (RN) with valid, current, unrestricted license in the state of operations.

Two years of ICD-9, CPT coding or managed health care experience or education equivalency.

Knowledge / Skills / Abilities

Answers the utilization management phone and fields calls for the case managers.

Creates, maintains, updates and files all case management charts.

Maintains master case management list.

Assists providers and members by quoting benefits, verifying eligibility and answering questions about appeals.

Minimum one (1) year of experience in quality management.

Strong problem solving, project management, group facilitation and teamwork skills.

Assists in the coordination of the quality management/utilization management department activities with other medical center departments.

Acts as a consultant for appropriate departments on quality management, utilization management and risk management activities.

Assists with quality management studies through data collection, data input and report development.

Assists the director of quality and utilization management for QM and UM in the formulation of department goals and objectives.

3 years clinical experience as a Licenses Practical Nurse

Diploma or Associate's Degree accredited LPN program

Input of MDS/care plan into EMR system.

Lead weekly task oriented staffing meeting involving all disciplines involved in MDS completion.

Report to DON/ADON any omissions/trends with MDS/Care Plan process involving other departments. Collaboration with ADON for RN signatures weekly on MDS.

Completion of ancillary forms as needed (restraint use, psychoactive med use, self admin. of med, etc.).

Utilization Management experience highly preferred

Education Coordinator for Utilization Management

Ensures the design, implementation and evaluation of a cost-effective unit-based orientation process that focuses on knowledge, skills and relationships

Coordinates/Conducts required training to close performance gaps in knowledge and skills

BLS certification from the American Heart Association required

2 years clinical nursing experience required

3 years of Experience in a hospital or insurance industry.Knowledge of medical necessity tool guidelines preferred.

LPN II Utilization Review Coordinator

Pay Range: $21.67 - $34.67 / hour

Performs utilization reviews in accordance with the hospitals UM plan to ensure adherence to federal regulations

Educate patient and family of on the lack of medical necessity on for continued stays, HINN issuance.

Conducts inpatient concurrent and retrospective review for Medicare beneficiaries and self-pay patients based on CMS guidelines.

Minimum of 2 years in a CHHA, LTHHCP, LHCSA or managed care organization preferred

Knowledgeable regarding Federal and State regulations as they apply to a CHHA

Current, Active New York State LPN licensure