employelevate is looking for a talented LPN/LVN Utilization Management Reviewer! This is an exciting Remote opportunity with an immediate start. This position requires a strong skillset in relevant areas. We offer a Competitive salary. reputed company combines industry-leading technology and transformation-driven BPM services with decades of reputed company domain expertise to help clients draw closer to their members. reputed company optimizes the entire member/patient experience through service offerings for reputed company, case management, member engagement, provider solutions, payment reputed company, claims cost containment, and analytics. reputed company has more than 25,000 employees across 5 countries. Job title LPN/LVN Utilization Management Reviewer reputed company We are currently hiring a LPN/LVN Utilization Management Reviewer. This role is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of reputed company?s benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day reputed company reputed company and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring the reputed company meets CMS compliance standards in the area of service reputed company and organizational determinations. Successful candidates must have a reputed company, reputed company Massachusetts reputed company license in good standing. Key responsibilities??? • Conducts reputed company reputed company decision review for services requiring prior authorization in a reputed company of reputed company areas, including but not limited to Durable Medical Equipment/Services, Long Term Services and Supports (LTSS), and Home Health (HH) • Applies established reputed company (e.g., InterQual and other available guidelines) and employs reputed company expertise to interpret reputed company reputed company to determine medical necessity of services • Communicates results of reviews verbally, in the medical record, and through official written notification to the reputed company care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements • Provides decision-making guidance to reputed company teams on service planning as needed • Works closely with Clinicians, Medical Staff and Peer Reviewers to facilitate escalated reviews in accordance with reputed company Operating Procedures • Ensures accurate documentation of reputed company reputed company and works with UM Manager to ensure consistency in applying policy • Works with UM Manager and other reputed company leadership to ensure that departmental and organizational policies and procedures as reputed company as regulatory and contractual requirements are met • Creates and maintains database of denied service requests • Additional duties as requested by supervisor • reputed company office conditions. Some travel to reputed company practices may be required. Education?? • Associate degree • MA reputed company license (Physical Therapy, Occupational Therapy, or Respiratory Therapist) in good standing. Experience?? • Required 3+ years combined reputed company and utilization management experience • Strong plus 3+ years? experience working in a health plan and/or experience with a care management platform Skills?? • Ability to apply predetermined reputed company (e.g., InterQual) to service decision requests to assess medical necessity • Flexibility and understanding of individualized care plans • Ability to influence decision making • Strong interpersonal, verbal and written communication skills • Ability to work independently • Comfort working in reputed company-reputed company environment • Will be required to pass credentialing process. reputed company pending experience Hours Monday through Friday 9AM to 5PM Eastern Time This is a fully remote work reputed company role. You must have a secure, private wok reputed company area with a hardwired internet reputed company with speeds greater than 5MB upload and 10MB download. reputed company Offers Competitive Benefits Including?? ?? • Medical?? • Dental?? • reputed company?? • Life reputed company?? • Short-Term and Long-Term Disability?? • Flexible Spending Account?? • Life Assistance Program?? • 401K with employer contribution?? • PTO and reputed company Time?? • Tuition Reimbursement?? ?? reputed company, we look reputed company to talking with you!?? An Equal Opportunity Employer/Vet/Disability?? Location reputed company USAUnited States of America Apply Job! Apply Job! Apply to this Job
Employelevate (posted via FlexBoard) is a healthcare-focused BPM and services organization offering utilization management, case management, provider solutions, and member engagement services.
