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Utilization Management LPN/LVN
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Location
Work At Location Address
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Type
Full Time
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Status
Inactive
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Job Published
06-03-2025
Description
Job Summary
We're looking for someone with 3-10 years of experience as a Utilization Review Coordinator to join our healthcare team. The ideal candidate will have strong experience with medical records management and a solid background as a Licensed Practical Nurse. This role requires excellent medical terminology knowledge and the ability to review and assess patient care plans for medical necessity and appropriate level of care.
Responsibilities
- Works with leadership, clinical staff, key internal departments, and external customers to ensure optimum clinical outcomes for members
- Reviews and interprets members’ medical records and compares them against proprietary and evidenced-based criteria to determine eligibility for bill sharing and advocacy for additional programs and interventions; determines if the medical record documentation supports the eligibility of requested and/or billed services
- Abstracts review-related data/information accurately and timely in appropriate review systems by the appropriate means. Provides accurate and timely submission of all administrative and review-related documents to appropriate parties
- Performs ongoing reassessment of review process to offer opportunities for improvement and/or change
- Reviews requests for genetic testing to determine eligibility for sharing and implements appropriate reimbursement strategies
- Advocates for members using the Medi-Share program to meet their health care needs
- Performs case reviews, checks medical records, speaks with patients and care providers regarding treatment and collaborates with plan of care
- Reviews pre-notification of services and clinical information for care management intervention and medical appropriateness
- Performs clinical reviews paying close attention to the appropriateness of healthcare expenditures to include length of facility stays and outpatient therapy services
- Performs concurrent review and discharge planning for inpatients
- Provides for continuity of care
- Researches and assists the negotiations for LOA/SCAs for inpatients transitioning to different level of care
- Assures appropriate levels of care are received by patients
- Provides appropriate consultation and referral to intra- and interdepartmental resources to ensure members receive optimum services offered by organization
- Manages assigned clinical caseload meeting SLAs
- Performs administrative and clinical processes to ensure team and departmental goals are met
- Delivers accurate and comprehensible verbal and written communication to external customers while complying with organizational HIPAA requirements
- Maintains accurate and timely records of all communications and interventions
- Attends all required department and organization meetings
- Contributes to the exercise and expression of Christian Care Ministry’s Christian beliefs
- All other duties as assigned
Qualifications
- Current LPN license in good standing
- Experience working in a clinical or healthcare setting with direct patient care responsibilities
- Ability to work independently while managing multiple cases with strict deadlines
Requirements
- Medical Records•3 - 10 years
- Licensed Practical Nurse•2 - 10 years
- Medical Terminology•3 - 6 years
- Attention to Detail
- Communication
Nice to Have
- Insurance Verification•1 - 3 years
- Time Management
About Us
Christian Care Ministry (Medi-Share) offers the opportunity to join the leading healthcare sharing community, connecting with a nationwide network of Members who provide support through prayer. You can also access Telehealth providers through the Medi-Share app and earn rewards by referring friends. With the Medi-Share program, which began in 1993, you can be part of a healthcare movement that aims to share healthcare burdens and save on healthcare costs.
