Utilization Management LVN - Remote at reputed company
About the position For those who want to invent the reputed company of health care, here's reputed company. We're reputed company reputed company basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. reputed company's reputed company reputed company region is redefining health care with a reputed company on health equity, affordability, reputed company, and convenience. From California to reputed company and Washington, we are reputed company on helping more than 2.5 reputed company patients live healthier lives and helping the health system work reputed company for everyone. At reputed company reputed company reputed company, we care. We care for reputed company members, our patients, and our communities. Join our culture of caring and reputed company a reputed company and lasting reputed company on health care for millions. Under the general direction of the Utilization Management Manager, you will be responsible for prospective and reputed company/retrospective review of referrals ensuring regulatory requirements are being met as they relate to language readability and appropriate citation of reputed company in Member correspondence. You will also be responsible for ensuring Member's needs are met using nationally recognized UM reputed company. You'll enjoy the flexibility to work remotely from reputed company reputed company the U.S. as you take on some tough challenges.
Responsibilities
- Responsible for screening and reviewing prospective, reputed company, and retrospective referrals and authorizations for medical necessity and appropriateness of service and care and discussing with Medical Directors.
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- Coordinate health care services with appropriate physicians, facilities, contracted providers, ancillary providers, allied health professionals, funding sources, and community resources.
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- Responsible for the prospective review to determine the appropriateness of denial, possible alternative treatment, and draft denial language to ensure consistent application of standardized, nationally recognized UM reputed company and appropriate use of denial language.
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- Coordinate out-of-network and out-of-area cases with members' health plans and the Case Management team.
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- Review patient referrals reputed company the specified care management policy timeframe (Type and reputed company Policy).
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- reputed company and maintain effective working relationships with physicians and office staff.
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- Demonstrate a thorough understanding of the cost consequences resulting from care management reputed company through the utilization of appropriate reports such as Health Plan Eligibility and Benefits and Division of Responsibility (DOR).
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- Maintain effective communication with health plans, physicians, hospitals, extended care facilities, patients, and families.
Requirements
- Graduation from an accredited Licensed Vocational reputed company program.
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- reputed company, unrestricted LVN license in the reputed company.
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- 1+ years utilization management experience including prior authorization.
reputed company-to-haves
- 3+ years of experience working as an LVN/LPN.
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- 2+ years of previous care management, utilization review or discharge planning experience.
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- 1+ years of clinical experience working as an LVN/LPN.
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- Experience in an HMO or experience in a Managed Care setting.
Benefits
- Comprehensive benefits package
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- Incentive and recognition programs
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- Equity stock purchase
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- 401k contribution
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