Retrospective Review LPN

Daily Responsibilities:

• Reviews medical records against specific guidelines and recommends a case disposition.

• Applies clinical knowledge in the assessment, evaluation and interpretation of clinical notes submitted by the provider.

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

• Documents the clinical aspects of the case and the reasoning for the determination outcome in numerous databases.

• 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 including Sidewinder and documents receipt, disposition and other noteworthy aspects of the cases in the application.

Hours for this Position:

M-F 8am – 5pm

Advantages of this Opportunity:

• Competitive salary, negotiable based on relevant experience

• Benefits offered, Medical, Dental, and Vision

• Fun and positive work environment