Retrospective Review LPN

Job Title: Retrospective Review LPN

Are you an experienced LPN with Utilization Review experience 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!

Position Summary:

As the Retrospective Review LPN, you would be responsible for reviewing medical records against specified guidelines and applying clinical knowledge in the assessment, evaluation and interpretation of clinical notes submitted by providers. 

More Insight of Daily Responsibilities: 

• Evaluates the medical record so that patient age, time of day, severity of injury, availability of medical resources, etc. are considered 

• Documents the clinical aspects of the case and the reasoning for the determination 

• Serves in all phases of the reconsideration process 

• Verifies eligibility, timeliness and record completeness of ER PLP cases and follows up with the provider as necessary

• Electronically enters claim detail information in organization applications 

• Assists in resolving provider issues and keeps communication with internal departments such as Claims and Appeals

• Participates in process development and testing of new process implementation

• Evaluates data input and output for accuracy and ensures compliance with data integrity and corporate compliance directives

• Participates in ad-hoc projects that require clinical evaluation of medical records as directed by the Manager and/or Director

Hours for this Position: Monday-Friday 8:00am-5:00pm 

Advantages of this Opportunity:

• Competitive salary, negotiable based on experience

• Benefits offered, Medical, Dental, and Vision

• Fun and positive work environment

• Weekly deposit options