LPN LVN Case Management Analyst - Medicare Clinical Operations
11 hours ago
Description
• Responsible for collaborating with healthcare providers, members, and business partners. • Evaluate medical necessity and promote effective use of resources. • Conduct reviews in compliance with medical policy and contracts. • Support all Utilization Management activities, including review of medical services. • Proficient knowledge of policies, Medicare, HIPAA, and NCQA standards required.
Requirements
• Current Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). • Active unrestricted license in state of residency; Compact license a plus. • Minimum 2-3 years clinical experience. • Experience in regulated managed care setting preferred. • Strong customer orientation. • Strong organizational, planning, and communication skills. • Working knowledge of medical coding (CPT/HCPCS/ICD-10) and claims process a plus. • Knowledge of National Coverage Determinations and MCG criteria are a plus. • Excellent time management skills. • Must be available to work rotating weekends and 2 holidays a year.
Benefits
• Comprehensive health-related benefits including medical, vision, dental, and well-being programs. • 401(k) with company match. • Company paid life insurance. • Tuition reimbursement. • Minimum of 18 days of paid time off per year. • Paid holidays.
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