What are the responsibilities and job description for the Medical Case Manager LVN - Concurrent Review position at SUNSHINE ENTERPRISE USA LLC?
Company Overview : Our client is a leading healthcare located in Orange CA seeking a medical case manager for Concurrent Review with an Licensed Medical Nurse (LVN) background.
Position Summary : The successful candidate should hold a current unrestricted LVN license with 3 years of nursing experience 1 year as a Clinical Nurse Reviewer along with 1 year of utilization management / prior authorization review experience.
Work Duration : up to 6 months
Work Schedule : Thursday Monday
Work type : Onsite with a possibility to Telework
Position Responsibilities :
- Review requests for medical appropriateness using established clinical protocols.
- Verify and process specialty referrals diagnostic testing outpatient procedures home health care services and durable medical equipment via telephone or fax.
- Screen requests for review by the Medical Director gather necessary medical information communicate decisions and document outcomes in the utilization management system.
- Ensure accurate coding (ICD10 CPT4 HCPCS) and coverage verification specific to Health s line of business.
- Address health network enrollments and liaise with Customer Service regarding networkrelated issues.
- Identify and report complaints to supervisors and escalate over / under utilization cases to the Medical Director.
- Maintain productivity and quality standards consistently.
- Complete additional assignments and projects as assigned.
- Assist in identifying staff training needs and maintain updated data resources.
Requirements
Experience & Education :
Necessary Attributes :
Benefits
Competitive salary package
Criteria : - BSN / Diploma in Nursing -At least 2 years Experience - Medical License
Education
Criteria : - BSN / Diploma in Nursing -At least 2 years Experience - Medical License
Key Skills
Project Portfolio Management,Motivational Interviewing,HIPAA,Computer Skills,Intake Experience,Lean Six Sigma,Conflict Management,Case Management,Team Management,Program Development,Social Work,Addiction Counseling
Employment Type : Full Time
Experience : 1-3 years
Vacancy : 1
Monthly Salary Salary : $ 1000 - 5000
Salary : $1,000 - $5,000
