We are seeking a highly skilled and detail-oriented LPN Medical Reviewer I to join our team. As a Medical Reviewer, you will play a critical role in performing medical reviews, utilization management, and appeals, utilizing established criteria sets and clinical guidelines to ensure high-quality patient care. This is a full-time, 40 hours/week position, with the opportunity to work from home after 6 months of on-site training and meeting production goals and quality checks.
Key Responsibilities:
- Perform medical reviews and make reasonable charge payment determinations
- Conduct authorization processes, ensuring coverage for appropriate medical services within benefit and medical necessity guidelines
- Utilize allocated resources to back up review determinations and provide education to members and their families/caregivers
- Participate in quality control activities and respond accurately and timely to members and providers with appropriate documentation
Requirements:
- Bachelor's degree in Social Work or graduate of an accredited school of Licensed Practical Nursing or Licensed Vocational Nursing
- 2 years of clinical experience
- Active, unrestricted LPN/LVN licensure from the United States and in the state of hire
- Working knowledge of word processing software and good judgment, customer service, and organizational skills
Preferred Qualifications:
- Associate Degree in Nursing or graduate of an accredited school of nursing
- Working knowledge of spreadsheet and database software
- Demonstrated oral and written communication skills and ability to persuade, negotiate, or influence others
What We Offer:
- Comprehensive benefits package, including subsidized health plans, dental and vision coverage, 401k retirement savings plan, and life insurance
- Paid Time Off (PTO) and education assistance
- Opportunities for professional growth and development in a diverse and inclusive workplace
How to Apply:
If you are a motivated and detail-oriented individual with a passion for delivering high-quality patient care, please submit your application. Our recruiting team will review your resume and may contact you for a brief telephone interview or email communication to verify resume specifics and salary requirements.
Equal Employment Opportunity Statement:
We are an Equal Opportunity Employer and maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information, or any other legally protected status.
Apply Now