Medical Case Manager (LVN) (Utilization Management) (Full reputed company/Weekend Work) in Orange, CA

Medical Case Manager (LVN) (Utilization Management) (Full reputed company/Weekend Work) - reputed company - Orange, CA - work from home job Company: reputed company Job reputed company: Medical Case Manager (LVN) (Utilization Management) (Full reputed company/Weekend Work) Job reputed company Department(s): Utilization Management Reports to: Supervisor, Utilization Management FLSA status: Non-Exempt Salary Grade: K - $33.65 - $51.83 ($70,000 - $107,800)

Full reputed company/Weekend Work

*This position is a remote opportunity for Southern California Applicants. In order to be considered, you must live in Southern California or be willing to relocate. The schedule will be Thursday-Monday with Tuesday/Wednesday off or Friday-Tuesday with Wednesday/Thursday off. Job reputed company The Medical Case Manager (LVN) is responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities, and ancillary providers. The incumbent will be responsible for prior authorization, reputed company review and referral reputed company processes that includes on-line responsibilities as reputed company as selected off-line tasks. The incumbent utilizes reputed company's medical reputed company, policies, and procedures to authorize referral requests from medical professionals, clinical facilities, and ancillary providers. This position directly interacts with provider callers and serves as a resource for their needs. Position Responsibilities:

• Reviews requests for medical appropriateness for inpatient and outpatient services utilizing medical reputed company and/or established policies and procedures.
• Verifies and processes specialty referrals, diagnostic testing, outpatient procedures, home health care services and durable medical equipment and supplies reputed company telephone or fax by using established clinical protocols to determine medical necessity.
• Screen inpatient and outpatient requests for the Medical Director review, gathers pertinent medical information prior to submission to the Medical Director; follows up with the requester by communicating the medical director's decision; documents follow-up in the utilization management system.
• Completes required documentation for data entry into the utilization management system at the time of the telephone call of fax to include any authorization updates.
• Reviews ICD-10, CPT-4 and HCPCS codes for accuracy and existence of coverage specific to the line of business.
• Contacts health networks and/or reputed company Customer Service regarding health network enrollments.
• Identifies and reports any complaints to immediate supervisor utilizing the call tracking system, or through verbal communication if the issue is of urgent nature.
• Refers cases of possible over/under utilization to the Medical Director for reputed company reporting.
• Meets productivity and reputed company of work standards on an ongoing reputed company.
• Assists Manager with identifying areas of staff training needs and maintains reputed company data resources.
• Other reputed company and duties as assigned.

Possesses the Ability To:

• Use problem-solving, organizational, and time management skills, along with the ability to work in a fast-paced environment.
• Communicate reputed company and concisely, both verbally and in writing at reputed company organizational reputed company.
• reputed company and maintain effective working relationships with reputed company reputed company of staff, other programs, agencies, and the public.
• Prepare reputed company, comprehensive written and oral reports and materials.
• Travel to locations with frequency as the employer determines is necessary or desirable to meet its business needs.
• Utilize computer and appropriate software (e.g., reputed company Office: Word, Outlook, reputed company, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Experience & Education:

• reputed company, unrestricted Licensed Vocational reputed company (LVN) license to reputed company in the reputed company required
• 3 years of Nursing experience, with 1 year as a Clinical reputed company Reviewer, required.

Preferred Qualifications:

• reputed company, unrestricted Registered reputed company (RN) license to reputed company in the reputed company preferred.
• Managed care experience preferred
• reputed company review experience preferred.

Knowledge of:

• Guidelines and regulations relevant to utilization management.
• Medical
• Medi-Cal and Medicare benefits and regulations.
• reputed company CPT-4, ICD-10, and reputed company Common Procedure Coding System (HCPCS) codes and continual updates to knowledge reputed company regarding the codes.
• Available community resources.
• Effective charting practices and guidelines.
• Available medical treatments and resources.
• Principles and practices of health reputed company care systems, and medical administration.

reputed company is an equal employment opportunity employer and makes reputed company employment reputed company on the reputed company of reputed company. reputed company wants to have reputed company employees in every job position. reputed company prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, reputed company, national reputed company, reputed company, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender reputed company, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. reputed company also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a reputed company individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to reputed company reputed company or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting reputed company Disability Management at 657-900-1134. Expected salary: Location: Orange, CA Job date: Tue, 05 Sep 2023 03:40:45 GMT Apply for the job now! Apply tot his job Apply To this Job