LPN Jobs

This job ad has been posted over 40 days ago...

0

applicants

Job Description:
Under the direction of the Health Care Manager, the RN/LPN will ensure that requests for review of services are expedited in a timely fashion to meet contractual standards and ensures that all reviews are conducted using nationally recognized and evidence based standards such as McKesson Interqual Criteria. The RN/LPN is responsible for implementing and coordinating all utilization management functions relating to prior authorization, concurrent and retrospective review of services to Nevada Medicaid recipients.
Job Essential Functions:
• Timely review of prior authorization, concurrent and retrospective review requests, both inpatient and outpatient.
• Determines utilization decisions (both approval and denials) based upon nationally recognized guidelines and McKesson Interqual Criteria.
• Maintains current knowledge of benefits under the Nevada Medicaid Program.
• Reviews prior authorization, concurrent and retrospective review requests with the Medical Director as needed.
• Maintains current and thorough knowledge of McKesson Interqual Criteria.
• Reviews medical records to determine appropriateness of medical services or level of care.
• Performs audits of medical records as needed.
• Works closely with providers to ensure coordination of care.
• Protects confidentiality of utilization review, quality management information and recipient identification.
• Assists the Health Care Manager and Department Directors in preparation for audits and other regulatory activities.
• Performs other duties as assigned.
Skills and Qualifications
• Registered Nurse or Licensed Practical Nurse with active non-restricted license in the state of Kansas.
• Minimum three years experience in an acute care setting
• Minimum one year experience in Utilization Management, Case Management or equivalent
• Strong verbal and written communication skills.
• Above average computer/technical skills.
• Knowledge of medical coding including ICD-9 and CPT codes sets is desirable.
• Strong clinical background.
• Ability to evaluate medical records and other healthcare data.
• Ability to exercise good judgment and tact in relating to contracting health care providers and Medicaid recipients
• Ability to accurately complete tasks within established timeframes.
• Ability to effectively prioritize multiple tasks and deadlines.
• Ability to maintain confidentiality.


Location: Topeka
Compensation: $28.00;hour
Principals only. Recruiters, please don't contact this job poster.
Please, no phone calls about this job!
Please do not contact job poster about other services, products or commercial interests.

Your name:
Your e-mail:
Message or letter of intention:
Upload resume/CV:	Max. 3 MB. Recommended formats: PDF, RTF, DOC, ODT.
Anti-Spam
or cancel

« Go back to category
Is this job ad fake? Report it!   
Recommend to a friend

Published at 01-23-2012
Viewed: 19 times