LPN Utilization Management Reviewer - Case Management - Full Time

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    "ExternalDescriptionStr": "<p style=\"margin-left:0in;\"><strong><u>This position is eligible for up to $15,000.00 Sign on Bonus for those that are eligible. ($7,500.00 for those with less than one year of experience)</u></strong></p><p style=\"margin-left:0in;\">&nbsp;</p><p style=\"margin-left:0in;\"><span style=\"color:navy;font-family:&quot;Times New Roman&quot;,serif;\"><i><strong>Summary</strong></i></span></p><p><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and the Robert Packer Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for reimbursement of patient care services.&nbsp; The responsibilities include:</span></span></p><ul><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Facilitating communication between physician offices, payers, Care Coordination and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and to assist in ensuring generation of clean claims in a timely manner</span></span></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Securing authorization as appropriate</span></span></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Documenting payer authorization</span></span></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Facilitating issue resolution with payer sources in collaboration with other hospital departments or clinic offices as appropriate</span></span></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Demonstrating ongoing competence in payer requirements, as defined collaboratively with Patient Business Services and Care Coordination</span></span></li></ul><p><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Additionally, the position works closely with the Care Coordination department to support data collection and aggregation associated with UM processes and operations.</span></span></p><p style=\"margin-left:0in;\"><span style=\"color:navy;font-family:&quot;Times New Roman&quot;,serif;\"><i><strong>Experience</strong></i></span></p><p><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Minimum of five years clinical experience in an acute health care setting. Must possess strong communication and organizational skills, be able to work independently and to complete work within specified time frames.&nbsp; Knowledge of health benefit plans and related UM requirements preferred.&nbsp; Experience with CPT/ICD coding, medical record or chart auditing, and experience in utilization management processes preferred.&nbsp;Knowledge of computer applications (such as Microsoft word processing and spreadsheets) desirable</span></span></p><p><span style=\"color:navy;font-family:&quot;Times New Roman&quot;,serif;\"><i><strong>Education/License</strong></i></span></p><p><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Current LPN licensure or eligibility for licensure required</span></span></p><p style=\"margin-left:0in;\"><span style=\"color:navy;font-family:&quot;Times New Roman&quot;,serif;\"><i><strong>Essential Functions</strong></i></span></p><ol><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Conducts validation of the authorization/certification process for elective short procedures and inpatient care services in collaboration with physician offices, hospital Business Office, Care Coordination and other hospital departments as appropriate.</span></span><ol><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Ensures documentation and communication of authorizations and certifications as appropriate.&nbsp;</span></span></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Performs routine admission and discharge notification according to payer requirements.</span></span></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Assists to ensure compliance with documentation requirements and guidelines of third-party payers, regulatory and government agencies.</span></span></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Develops and maintains collaborative relationships with members of the healthcare team.</span></span></li></ol></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Proactively researches case findings related to payer audits of UM decisions and prepares input for supporting documentation to complete the revenue cycle process, coordinates as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate.</span></span><ol><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Serves as liaison with payers, hospital Business Office, physician offices, Care Coordination and other hospital departments as appropriate for resolution of issues or questions.</span></span></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Collaborates with the hospital Business Office, physician offices, Care Coordination and other hospital departments as appropriate to track and monitor the status for denials and appeals.</span></span></li></ol></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Participates in performance improvement and educational activities.</span></span><ol><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Serves as an educational resource to other members of the healthcare team with regards to changes in reimbursement, payers, and/or utilization requirements.</span></span></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Participates in departmental long-range planning to meet the needs identified through utilization management activities.</span></span></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Demonstrates appropriate problem solving and decision-making skills.</span></span></li><li><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">Maintains the required 8 hours of continuing education per year.</span></span></li></ol></li></ol><p style=\"margin-left:0in;\"><span style=\"color:navy;font-family:&quot;Times New Roman&quot;,serif;\"><i><strong>Other Duties</strong></i></span></p><p><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\">It is understood that this description is not intended to be all inclusive, and that other duties may be assigned as necessary in the performance of this position.</span></span></p><p><span style=\"font-family:&quot;Arial&quot;,sans-serif;\"><span style=\"font-size:10.0pt;\"><strong>Pay Range $20.38-$31.81/hr Dependent on years of applicable experience.&nbsp;</strong></span></span></p>",
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