Medical Review Coordinator / LPN

MedWatch•Lake Mary, FL

7d•$23 - $27

About The Position

The Medical Review Coordinator performs duties in accordance with MedWatch procedures and review standards, URAC standards, and state certification requirements. The role reviews medical information, supports utilization review and certification decisions, coordinates follow-up with clinical reviewers and claims offices, and contributes to quality management activities. The position is based in a typical office or home-office environment and involves prolonged sitting at a computer and operating standard office, computer, and phone equipment. The salary range is $23 to $27 per hour.

Requirements

Associate’s degree or equivalent education and experience.
Current, unrestricted Licensed Practical Nurse (LPN) license in the state of practice.
Three years of clinical nursing experience.
Good organizational and time-management skills.
Excellent verbal and written communication skills.
Ability to handle difficult situations tactfully and diplomatically.
Effective problem-solving and decision-making skills.
Strong computer skills, including proficiency with Microsoft Office Suite products: Word, Excel, and PowerPoint.

Responsibilities

Review medical data received by mail or fax and enter it into the clinical record for review by the utilization review specialist.
Review precertification cases forwarded by the utilization review specialist and determine certification decisions; document information according to MedWatch policy.
Follow up after procedures to obtain pathology reports when appropriate and send notification memos to the claims office regarding results and any additional treatment needed.
Discuss cases with insufficient clinical information with the supervisor before sending them to the appropriate Physician Advisor; follow up to ensure timely responses within MedWatch guidelines.
Obtain clinical information for pregnancy cases as directed by MedWatch protocol.
Discuss cases with the Medical Review Specialist, including potentially high-risk obstetric cases, document information for the claims office, and forward cases to the assigned utilization review specialist for follow-up at delivery.
At the direction of the Medical Review Specialist, discuss potential case-management referrals with the case-management supervisor and refer cases to the claims office as directed.
Obtain discharge dates and bill totals for the Medical Review Specialist at discharge to expedite case closure.
Adhere to company policies stated in the employee handbook.
Assist with projects as directed by the Director of Utilization Review.
Participate in the Quality Management Program by following company policies and procedures and identifying opportunities for improvement to support quality services.
Perform other duties or responsibilities that may be assigned; duties may change at any time with or without notice.