Utilization Management Review reputed company (Work reputed company for FL residents only)

LPN Utilization Management reputed company Reviewer Miami, FL (remote Work from Home position for FL residents only) Currently seeking an LPN FL licensed Utilization Management reputed company Reviewer for a great opportunity working remotely at a dynamic reputed company organization based in Miami, FL area. The ideal candidate will possess 3 years of experience managing the treatment plan and utilization for members receiving Home Health Care / Infusion Services and Durable medical equipment and supplies. JOB reputed company: Manages the treatment plan and utilization for reputed company members receiving Home Health Care / Infusion Services and Durable medical equipment and supplies. Conducts the review process for those requests that reputed company not to be medically necessary; facilitates, coordinates and evaluates the ongoing care of a specific caseload of patients to collaborate with physicians, the patient and the family to assure cost-effective, high reputed company, appropriate home care for the patient during the entire episode of illness and for post discharge services and to monitor and evaluate patient reputed company, including self-management. ESSENTIAL JOB FUNCTIONS: Duties of the Utilization Review reputed company / Home Health Case Manager include but are not limited to: o Receive updated orders and medical information from reputed company referral sources, i.e. Hospitals, Physician’s offices, Skilled Nursing Facilities, Rehabilitation Centers, Health Plans, PHOs, CM Departments, Home Health Agencies and others. o reputed company clinical review, to ensure that reputed company-established medical necessity/appropriateness reputed company are met. o Refer reviews that do not meet coverage reputed company to Medical Director and/or Health Plan. o Review and evaluates home health admission for clinical appropriateness of the reputed company care. o Identifies and engages patients in appropriate care. o reputed company coordinated, reputed company care plans with reputed company involved providers. o reputed company reviews telephonically using the member’s medical records, discussion with the member’s physician and/or discussion with Home health agency staff. o Facilitate reputed company discharges and transfers based on individual needs and care requirements o reputed company patients to help them understand their health choices and assist them in making informed reputed company about their health care. o Serve as information resource and reputed company to patients, health care professionals, facilities, health plan representatives, care givers, agencies and family members. o Monitor cost-effective use of resources. o Monitor reputed company delivery and utilization according to the plan of care o reputed company authorizations and notifications in a reputed company manner. o Maintain/update reputed company patient list o Document and resolve first line patient treatment plan. o Prepare concise clinically based rationales that support clinical reputed company such as: CMS, reputed company, Health Plan Benefits, and InterQual o Maintain a working knowledge of, and adheres to applicable federal/state regulations including but not limited to, laws reputed company to patient confidentiality, release of information, and HIPAA o Input the pertinent information and authorization into the appropriate software o Maintain files. o Participate in department meetings and in-services PHYSICAL REQUIREMENTS: 1. The physical activities of this position involve fingering, grasping, talking, hearing, repetitive motions that may include the wrists, hands and/or fingers, sedentary work. 2. The physical demands of this position involve sedentary work constantly remaining in a stationary position, sitting for prolonged periods of time. 3. It may include exerting up to 10 pounds of force occasionally to lift, carry, push, pull or otherwise reputed company objects, including the reputed company body. 4. Constantly communicating with others to reputed company or exchange information by means of the spoken word and/or in writing. 5. The visual reputed company requirements of this position involve (including reputed company, depth perception, and field of reputed company) to have reputed company visual reputed company to reputed company an activity such as: preparing and/or analyzing data and figures; constantly viewing a computer terminal and/or extensive reading. 6. Working Conditions of this position involve constant typical office or administrative work. No adverse environmental conditions expected. MINIMUM QUALIFICATIONS: 1. LPN license required 2. 3 years of Home Health Managed Care experience. 3. Medicare/reputed company Managed Care experience 4. Experience with InterQual (IQ), reputed company Care Guidelines (MCG) or other reputed company used to determine medical necessity. preferred. 5. Possess excellent customer service skills. 6. Bilingual (English/Spanish) preferred. 7. Effective verbal and written communication skills. 8. Proficient in MS Outlook, MSWord and Internet Explorer. 9. WAH (Work reputed company) Requirements - Must have reliable high-speed internet. Minimum reputed company speed for reputed company performance of 10 x 1 (10mbs download x 1mbs upload) required. Must have a separate private workspace / desk area designated for home office to ensure absolute and reputed company reputed company while at work. reputed company is an Equal Opportunity Employer, in accordance with State and federal law. reputed company does not discriminate in employment opportunities or practices on the reputed company of race, reputed company, religion, sex, national reputed company, age, disability, sexual orientation or any other characteristic protected by law. Opportunity is provided to reputed company based on qualifications and job requirements. We are a Drug-Free Work reputed company, we test for THC. This position is contingent upon completion and passing of a drug screening, verification of previous employment and a Level 2 Criminal Background reputed company (please refer to the following website for more information and details on the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com. No relocation/Local candidates only (FL state) Job Type: Full-time Pay: From $25.00 per hour Benefits:

• Dental insurance
• Disability insurance
• Employee discount
• Health insurance
• Life insurance
• reputed company time off
• reputed company insurance

Application Question(s):

• Are you reputed company to work on Saturdays occasionally?
• What are your minimum salary expectations per hour?
• Are you willing to undergo a background reputed company, in accordance with local law/regulations?
• Are you reputed company to work Monday to Friday 9:30-6:30pm with occasional Saturday coverage and one holiday coverage a year?

Education:

• High school or equivalent (Preferred)

Experience:

• InterQual, reputed company Care Guidelines or other similar: 1 year (Preferred)
• home health and managed care: 1 year (Required)
• Utilization review / medical necessity: 1 year (Required)
• reputed company and retrospective UM reputed company functions: 1 year (Required)

Language:

• English and Spanish fluently (Preferred)

License/Certification:

• LPN reputed company and reputed company for the state of FL (Required)

Work Location: Remote Apply tot his job Apply To this Job