Hospital Case Manager

Valley Forge Medical Center (VFMC) is seeking an experienced and detail-oriented LPN to obtain Hospital pre-certifications with a strong background in hospital settings and a passion for patient advocacy. This role is ideal for Licensed Practical Nurses (LPNs) who are pursuing their Registered Nurse (RN) license and have experience managing clinical reviews and insurance authorizations. A CPUR certification is a plus.

In this role, you will review patient clinical information, including vitals and charts, to manage pre-certifications and advocate for patients by ensuring medical necessity is effectively communicated to insurance companies. Your ability to thoroughly understand patient cases and secure approvals is essential to support our patient care and revenue cycle teams.

Key Responsibilities:

• Analyze clinical documentation, including patient charts and vitals, to prepare pre-certification and authorization requests.
• Collaborate with physicians, nurses, and billing teams to ensure complete and accurate documentation for authorization submissions.
• Communicate with insurance companies to secure approvals for inpatient stays.
• Utilize software tools to upload clinical charts and streamline the authorization process.
• Advocate for patients by effectively presenting medical necessity in cases to insurance companies.
• Track and manage authorization requests and approvals, maintaining up-to-date records in the hospital’s electronic health record (EHR) and authorization systems.

Qualifications:

• Current LPN license required; pursuing RN preferred.
• Minimum of 2 years of experience in healthcare, specifically in hospital settings and insurance authorizations.
• Strong understanding of clinical charts, patient vitals, and medical necessity guidelines.
• Experience dealing with insurance companies for approvals, with knowledge of Medicare, Medicaid, and commercial insurance processes.
• Proficiency in EHR systems and authorization software.
• Excellent communication and organizational skills.

Preferred Skills:

• CPUR certification is a plus.
• Experience interpreting and assessing clinical documentation to advocate for patient care needs.
• Familiarity with medical terminology, treatment plans, and healthcare processes.
• Strong problem-solving skills and attention to detail.

This position offers a unique opportunity to combine clinical expertise with the administrative knowledge required to secure patient care approvals. Join our dedicated team at VFMC and make a difference in patients' lives.

Apply now to be part of our mission-driven team!

Job Type: Full-time

Pay: Up to $70,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Case management: 1 year (Preferred)

Ability to Commute:

• Lakewood, NJ 08701 (Preferred)

Ability to Relocate:

• Lakewood, NJ 08701: Relocate before starting work (Required)

Work Location: In person

Salary : $70,000