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.