LPN Reviewer – Remote

• Receives precertification requests for approval of admission, service, procedure, or equipment through fax, Web, or client specified MMIS system.
• Reviews requests by collecting additional data, applying appropriate clinical criteria (MCG or Interqual) and using clinical expertise to approve request or refer to physician for decision.
• Clearly writes clinical rationale for approval of request or referral to physician.
• Answers provider questions as required to complete review of request.
• Enters clinical decision in review application or client MMIS system.
• Formats and edits approval and denial letters as required by client.

Non-Essential Responsibilities:

• Performs other duties as assigned.

• Ability to work proficiently with Microsoft Word, Excel, and Power Point.
• Ability to analyze and evaluate medical information.
• Ability to provide good customer service skills
• Ability to sit and work at a computer for an extended period of time.
• Average manual dexterity in use of a PC, phone, sorting, filing and other office machines.
• Ability to perform well in team environment, with staff at all levels, to achieve business goals.
• Ability to function under pressure and with deadline oriented project demands as well as manage multiple initiatives.
• Ability to apply existing knowledge of health care marketplace including commercial and government insurance health plan organizations and HIPAA guidelines with their associated security requirements.
• Ability to work independently to meet predefined production and quality standards
• Working knowledge in and successful application of clinical review.

Work Conditions and Physical Demands:

• Primarily sedentary work in a general office environment
• Ability to communicate and exchange information
• Ability to comprehend and interpret documents and data
• Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
• Requires manual dexterity to use computer, telephone and peripherals
• May be required to work extended hours for special business needs
• May be required to travel at least 10% of time based on business needs

Certifications: (Required/Desired)

• Current, unrestricted LPN/LVN license required

Minimum Education:

• High School Diploma or GED required; successful completion of an accredited LPN educational program required

Minimum Related Work Experience:

• 2+ year’s diverse, acute care clinical experience
• 1+ year utilization review experience