LPN Case Manager Clinical Authorization - Relocation Offered

Description

General Summary of Position

Provides support for the Care Management Department by coordinating and promoting comprehensive quality cost-effective care.

Primary Duties and Responsibilities

• Assists in the identification of potential Case Management candidates through clinical review, selected diagnoses, etc. and makes appropriate referrals.
• Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
• Demonstrates behavior consistent with MedStar Health mission, vision, goals, objectives and patient care philosophy.
• Identifies and reports potential coordination of benefits, subrogation, third party liability, workers compensation cases, etc. Identifies quality, risk, or utilization issues to appropriate MedStar personnel.
• Initiates contact with providers to obtain clinical information to facilitate care or pending pre-certification requests. Interacts with assigned disease management populations of limited volume. Interaction is designed to improve patient access to care, and education regarding the disease and support services.
• Maintains current knowledge of MedStar Family Choice benefits and enrollment issues in order to accurately coordinate services.
• Maintains expertise in general benefit management and serves as a resource for MedStar Family Choice members, physicians, and staff for benefit interpretation and coordination.
• Maintains timely and accurate documentation in the IS System per Case Management policy.
• Participates in meetings, work groups, etc. as assigned.
• Processes pre-authorizations for medical necessity, LOC, covered benefits, and participation of the provider at the discretion of the guidelines and Medical Reviewer.
• Sends reviews to Medical Reviewer as appropriate. Coordinates review decisions and notifications, per policy.
• Provides after-hour coverage as required to meet departmental standards and District of Columbia contract.

Minimum Qualifications

Education

• Valid LPN License in the State of Maryland. required

Experience

• 1-2 years Utilization review experience required and
• 3-4 years Diverse clinical experience required

Licenses and Certifications

• LPN - Licensed Practical Nurse - State Licensure Valid LPN license in the State of Maryland or District of Columbia. Upon Hire required

Knowledge, Skills, and Abilities

• Knowledge of current trends in healthcare delivery and utilization review criteria.
• Ability to use computer to enter and retrieve data.
• Ability to create, edit and analyze (Word, Excel and PowerPoint) preferred

This position has a hiring range of $60,632 - $107,494

Category

[Healthcare - Nursing] Advanced Practice Registered Nurse (APRN)