LPN/LVN Case Management Analyst
6 days ago
Description
• Collaborates with healthcare providers, members, and partners to optimize benefits. • Conducts medical necessity reviews and compliance. • Supports all Utilization Management activities. • Maintains required licensures and adheres to guidelines. • Achieves operational objectives and departmental goals.
Requirements
• Current Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). • Active unrestricted license in state of residence; compact license a plus. • Minimum 2-3 years clinical experience. • Strong customer orientation and organizational skills. • Knowledge of insurance industry, medical coding (CPT/HCPCS/ICD-10), and claims process a plus. • Knowledge of National Coverage Determinations, Local Coverage Determinations, and MCG criteria are a plus. • Excellent interpersonal and communication skills. • Must be available to work rotating weekends and two 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. • Eligible for annual bonus plan.
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