Remote Bilingual Utilization Mgmt Nurse (LPN) – New York

Job Overview

  • Clinical License LPN
  • State(s) NY

About the job

Job Description:

All UM standard/ expedited Inpatient, Outpatient and Custodial Care clinical reviews for MLTC members.

 

Must Have Skills:

Must have experience in UM, experience with Turnaround Timeframes, good with computer systems and be able to learn a new system, have done clinical reviews and processed denials and partial denial determinations, know MCG and can use it, case presentation for medical reviews, know Medicaid/ Medicare guidelines.Bi-lingual Spanish, Bengali or Mandarin.

 

Day to Day Responsibilities:

All UM standard Inpatient, Outpatient and Custodial Care processes and workflows for any requests, verbal notifications for denials/partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews.

 

Required Years of Experience:

At least 1-2 years experience in UM.

 

Required Licensure / Education: Licensure required is a NY State License Practical Nurse -LPN NY

 

 

 

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