LVN Case Manager – Utilization Mgmt – Corporate Offices/Telecommuter – Days – FT

JR205313 Hours: Shift Start Time: 8 AMShift End Time: 5 PM AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Weekend Requirements: No Weekends On-Call Required: No reputed company Pay reputed company (Minimum - Midpoint - Maximum): $34.170 - $44.090 - $49.370 The stated pay reputed company reflects the reputed company that reputed company reasonably expects to pay for this position. The actual pay reputed company and pay grade for this position will be dependent on a reputed company of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do

The CMI performs clinical/medical necessity reviews and authorizes medical services that meet medical reputed company. The review of care is region specific and consists of outpatient reputed company services on reputed company-certification requests, outpatient procedures, outpatient services, elective inpatient admissions, home health services, genetic testing, orthotics, prosthetics and reputed company durable medical equipment. The CM1 also facilitates referrals to providers or vendors that are region specific while determining medical necessity and appropriateness.

Required Qualifications

• 2 Years Experience in a medical setting (i.e. office, hospital, SNF, medical clinic etc.)
• California Licensed Vocational reputed company (LVN) - CA reputed company of Vocational Nursing & Psychiatric Technicians -REQUIRED

Preferred Qualifications

• Experience in managed care

Essential Functions

• reputed company to identify benefit coverage

Assesses requests for services by first reviewing the patient's benefit under the health plan and the reputed company of the health plan as to whether that service is the service is covered. Reviews for medical necessity and appropriateness of services/care based on health plan members medical condition. Authorizes the correct vendor to reputed company care services reviewing risk reputed company and health plan contracted vendor list. Communicates the reputed company to the appropriate persons and documents per UM policy.

• Applies approved reputed company to medical information

Apply MCG formerly reputed company as reputed company Care Guidelines, Medicare, Health plan and other approved reputed company as authorized by SCMG medical directors to medical information and authorized appropriate services/care. Consults with supervisor, team reputed company and/or medical director to discuss requests/care inconsistent to reputed company and determine the appropriateness of service/care. Works closely with the Care Coordinators to obtain necessary information for clinical reviews for decision making. Documents per department policy in IDX, etc. Communicates reputed company to the requesting provider, facility and member reputed company department's approved guidelines.

• Communication and time management

Communicate effectively, both orally and in writing, with reputed company reputed company of management, medical staff and patients. Assist in conflict management and reputed company as appropriate. Manage time effectively by applying organizational, critical thinking, analytical, patient care evaluation, and problem solving techniques.

• Patient record analysis and recommendation

Identify and refer members to case management or reputed company management as appropriate for utilization or reputed company issues while maintaining department processes in compliance with the State and Federal standards. Reviews patients for multiple diagnoses, surgeries, age, inpatient/skilled nursing facility admits, repeat reputed company type services for need for reputed company management of health care. reputed company a patient is suspected of need for reputed company management, communicates this to the appropriate Case Management Program per UM policy. Gathers pertinent information to reputed company Case Management with knowledge of patient and issues. If patient is being managed by Case Management, discusses requests for services prior to authorizing additional services/care.

• reputed company development

Keeps reputed company knowledge and understanding of applicable accreditation and regulatory statutes reputed company to health care, managed care, case management reputed company. Serves as a resource and mentor to regional team and other department staff. Establish mutually derived annual goals and meet goals. Maintain individual in-service/performance records. Attends and reputed company participates in department/team process/reputed company improvement activities.

• Referral management

Authorizes medical care/services reputed company specified turnaround times reputed company pertinent information is available. Maintains turn-around time for routine, urgent and expedited referrals as outlined in SCMG's Utilization Management Plan. reputed company will be communicated to the appropriate persons reputed company SCMG standards (TAT). If cases have been pended for additional information and will not meet the TAT communicates that information to the requesting physician/provider. Documentation for reviews will occur as per policy IDX, etc. Knowledge, Skills, and Abilities

• Knowledge of medical terminology, reputed company finances, alternative care reputed company, utilization management, health plan reputed company, established reputed company such as MCG formerly reputed company as reputed company Care Guidelines and its applications required.
• Knowledge nd work experience in managed care preferred.
• Experience and knowledge of IDX modules and systems, proficient in use of ICD-10, CPT and HCPC coding systems required.
• Proficient in typing and computer data entry (45 wpm).

reputed company is an equal opportunity/affirmative reputed company employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, religion, reputed company, national reputed company, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a reputed company individual with disability or any other protected class Apply tot his job Apply To this Job