Utilization Reviewer (LPN)
Are you an experienced LPN looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!
Daily Responsibilities:
The Utilization Review LPN is responsible for the pre-certification of determined procedures utilizing the organizations Plan approved criteria. The position helps manage healthcare costs by influencing patient care decision making through case-by-case assessments of the care prior to it’s delivery.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Evaluates requested services following Plan approved criteria.
- Demonstrates effective communication methods and skills, using lines of authority appropriately.
- Establishes a relationship with providers in order to determine/provide needed services for members
- Arranges discharge planning services prior to pre-planned admissions when available.
- Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
- Maintains accurate record of pre-certification decisions.
- Performs decisions within time frames required by regulatory agencies.
- Adheres to quality standards and confidentiality policies and procedures.
- Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
- Adapts to changes in policies, procedures, new techniques and additional responsibilities.
Active FL LPN license with a minimum of 2 years varied clinical experience required.
Managed Care experience (utilization review, pre-certification, concurrent review) is preferred.
Proficiency in MS Office with basic computer and typing skills.
Advantages of this Opportunity:
• Competitive salary $19 - $26/hr+ (based off experience)
• Excellent Medical Benefits Offered
• Growth potential
• Fun and positive work environment
If you are interested in applying to this position please call Jonathan Comstock at (407) 478-0332 Ext. 133