Remote Utilization Management LPN/LVN – Tennessee

Job Overview

  • Clinical License LPN
  • State(s) TN

Full job description

Utilization Management LPN (M-F FROM YOUR HOME OFFICE)

HealthCare Strategies

Description
Do you want to work from the comfort of your own HOME? Do you want to work for a progressive company that is a leader in their industry?
F/T Position: Monday – Friday Day Shift.

JOB DESCRIPTION:

  • Responsible for the collection of personal and clinical information on participating Plan members for the purpose of:
  • Providing patient education services.
  • Rendering initial determinations of medical appropriateness for communication to the health benefit plan.
  • Identifying individuals whose health and/or expenses may be positively affected through application of Large Case Management.

SPECIFICS:

  • Perform telephonic Clinical Assessments
  • Obtain appropriate information from health care provider and or patient or family regarding planned procedure, admission, continued stay or discharge plan.
  • Interpret nationally recognized criteria to support recommendations for inpatient and outpatient services.
  • Identify and refer individuals whose health and/or expenses may be positively affected through the application of Case Management.
  • Document each call completely, accurately and promptly into the computer system.
  • Follow documented policies and procedures for the handling of confidential materials and/or patient specific information.
  • Answer direct telephone calls related to medical services in order to determine if prior authorization is required for the requested services.
  • Retrieve and acknowledge messages requesting medical services from voicemail.
  • Complete all medical necessity reviews and communicate outcomes to providers within the appropriate time frames.
  • Provide educational materials and direct callers to community services when indicated.
  • Provide coverage for professional colleagues.

 


REQUIREMENTS:

  • Active, unrestricted LPN License
  • Minimum internet speeds of 25Mbps download; 25 Mbps upload
  • 1+ years experience in hospital setting
ABILITIES/SKILLS:

  • Strong verbal communication skills
  • Problem-solving and decision-making skills
  • Ability to carry out detailed written or verbal instructions independently
  • Proficiency with Microsoft Office Suite (Outlook, Word)
PREFERRED:

  • 1+ years previous UM experience

During our over 40 years in business, HealthCare Strategies has earned a reputation for delivering quality services as a medical management provider and now through technology platforms by offering next generation, informatics-driven, health management services used singularly, or in tandem, with our highly effective clinical programs.

Thanks for visiting!

The Remote Nurse is a large online community and Job Board specializing in Remote Clinical Jobs for Nurses, Nurse Practitioners, and Physician Assistants.

Follow us!