Remote Utilization Review Specialist (LPN/LVN)

Job Overview

  • Clinical License LPN
  • State(s) Nationwide

Full job description

Utilization Review Specialist – Remote

Are you looking for a career opportunity with a fast-growing company that helps to transform lives? If so, then you’ve come to the right place. Invicta Health Solutions, a business division of RSi, seeks a full-time Utilization Review Specialist to augment our growing RCM team. As a Utilization Review Specialist, you have the unique opportunity to advocate for patients and their families, while working hand in hand with hospital personnel to review medical records and ensure adjudication from Government, Commercial, and TPL insurance carriers. Invicta incorporates artificial intelligence with human interaction to secure funding and provide a dynamic patient experience. Come join team!

Position Summary:
We are looking for a Utilization Review Specialist who specializes in Commercial and Government Carriers, Authorizations, Appeals, and has complete knowledge of Hospital Revenue Cycle Management. As a Utilization Review Specialist, you will provide leadership to designated areas of responsibility, including direction and supervision of Recovery staff. This leader will continuously develop all client relationships to ensure the organization is meeting and exceeding all revenue targets and client expectations.

Key Accountabilities:

  • Encourage a healthy work culture and environment by modeling positive, creative, and customer-focused characteristics.
  • Mentor team members to grow skill and prepare for future growth with the company.
  • Maintain effective, efficient, and productive operational workflow.
  • Work with senior leadership to produce defined financial results within a dynamic healthcare environment which meet and/or exceed customer requirements and company profitability goals.
  • Enforce disciplinary action as warranted concerning any employee misconduct.
  • Manage and develop a team to match resource needs.
  • Respond to daily questions and concerns raised by client in a timely and responsible manner.
  • Responsible for adjusting staff duties as may be required to accommodate procedural changes or additional needs that may occur.
  • Adhere to and supports organizational standards, policies, and procedures.
  • Perform other duties as assigned.
Skills/Abilities/Experience & Qualifications:
  • Current LVN or LPN License
  • Ability to pass a thorough background check.
  • Authorized to work for any employer in the United States
  • Exceptional customer service skills
  • Demonstrated communication, problem solving and case management skills, and the ability to act/decide accordingly.
  • Proficient with technology such as phone systems, computers, Microsoft software applications such as Word, Excel, Outlook, etc.
  • Excellent written and verbal communication skills
Preferred Skills:
  • Strong knowledge of Medicaid, Medicare, TPL, and Commercial insurance recovery practices
  • Medical Record review and diagnostics
  • Prior and Retro Authorizations
  • Appeal creation for all major payers.
  • Out-of-State Medicaid Recovery procedures
  • Strong knowledge of major hospital systems
Physical Demands/Working Conditions:
Work will be primarily performed remotely. Candidates must have a stable dedicated workspace and secure internet connectivity. Computer equipment will be provided by the Company. Requires prolonged sitting, standing, or walking. Requires on-camera interactions with colleagues, leadership, and occasionally, clients. Consequently, appropriate work attire and professional setting is required. Requires eye-hand coordination and manual dexterity enough to operate a computer keyboard, photocopier, telephone, calculator, and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 15 pounds occasionally. Work may be stressful at times. Must be an effective communicator with strong problem resolution abilities. Travel to Invicta Health Solutions Division offices and/or client facilities may be required from time to time. Training will often be performed on-site in an Invicta office location.

OSHA Category:
The candidate selected for this position will not be required to conduct any medical care. All employees must abide by client-required policies such as wearing masks, providing COVID-19 vaccination status and testing, in the event that any on-site visits occur.
This is a remote position.

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Receivable Solutions, LLC.
For more than 20 years, RSi has been a leading revenue cycle management service provider for the hospital and large physician practice market.

Company Website: rsircm.com

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