Utilization Management LPN/LVN

Christian Care Ministry•Atlanta, GA

1d•$25 - $34•Remote

About The Position

The Utilization Management LPN/LVN handles a diverse workload by performing prospective, concurrent, and retrospective utilization management/review-related functions while adhering to the organization’s governing guidelines, standard medical rules, and utilization management best practices. This individual will assist in identifying cost saving opportunities through patient assistant programs for genetic testing. In addition, this individual will monitor and analyze healthcare activity through medical billing and collaborate with RN Care Managers to provide clinical support for members. As a key contributor to the organization's culture and Christian values, the Utilization Management LPN/LVN will pray with members, family members, and medical providers and support them through difficult diagnoses. We're excited to onboard a compassionate, kind, seasoned professional with related experience and deep-rooted faith.

Requirements

Current unrestricted compact LPN/LVN license with sound knowledge of anatomy and physiology, medical terminology, and disease processes required
Graduate from an accredited Diploma, Associates Degree
Expert knowledge of Medi-Share program guidelines and processes
Strong organizational, prioritization, and process skills
Advanced Excel skills; intermediate Microsoft office skills (Outlook, Teams, Word)
Advanced knowledge of Salesforce, CSI/Eldorado use and documentation
Excellent computer skills – ability to access, research and use multiple software programs simultaneously and keyboard skills of at least 35 words per minute
Excellent research skills to using IT systems, internet, and phone
Accurate data collection, documentation, and analysis - provides effective and efficient collection and distribution of research data without the need for supervision; able to correlate research findings with solutions
Excellent ability to communicate effectively in written, oral, telephonic, and digital formats that build collaboration and facilitate positive outcomes
Ability to work independently and with a team regularly; able to perform assigned special projects with minimal assistance
Ability to comply with HIPAA, PHI, and all call compliance rules and regulations
Excellent ability to provide all content within a Biblical framework

Nice To Haves

2+ years of clinical experience and/or care coordination in an acute or med-surgical environment preferred
1+ years working with EMRs and medical record/abstraction of data required
Must be proficient in Microsoft Office Suite, internet/web navigation and research required

Responsibilities

Works with leadership, clinical staff, key internal departments, and external customers to ensure optimum clinical outcomes for members
Reviews and interprets members’ medical records and compares them against proprietary and evidenced-based criteria to determine eligibility for bill sharing and advocacy for additional programs and interventions; determines if the medical record documentation supports the eligibility of requested and/or billed services
Abstracts review-related data/information accurately and timely in appropriate review systems by the appropriate means. Provides accurate and timely submission of all administrative and review-related documents to appropriate parties
Performs ongoing reassessment of review process to offer opportunities for improvement and/or change
Reviews requests for genetic testing to determine eligibility for sharing and implements appropriate reimbursement strategies
Advocates for members using the Medi-Share program to meet their health care needs
Performs case reviews, checks medical records, speaks with patients and care providers regarding treatment and collaborates with plan of care
Reviews pre-notification of services and clinical information for care management intervention and medical appropriateness
Performs clinical reviews paying close attention to the appropriateness of healthcare expenditures to include length of facility stays and outpatient therapy services
Performs concurrent review and discharge planning for inpatients
Provides for continuity of care
Researches and assists the negotiations for LOA/SCAs for inpatients transitioning to different level of care
Assures appropriate levels of care are received by patients
Provides appropriate consultation and referral to intra- and interdepartmental resources to ensure members receive optimum services offered by organization
Manages assigned clinical caseload meeting SLAs
Performs administrative and clinical processes to ensure team and departmental goals are met
Delivers accurate and comprehensible verbal and written communication to external customers while complying with organizational HIPAA requirements
Maintains accurate and timely records of all communications and interventions
Attends all required department and organization meetings
Contributes to the exercise and expression of Christian Care Ministry’s Christian beliefs
All other duties as assigned

Benefits

100% paid Medical for employees/99% for family
Generous employer Health Savings Account (HSA) contributions
Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
6 weeks of paid parental leave (for both mom and dad)
Dental - two plans to choose from
Vision
Short-term Disability
Accident, Critical Illness, Hospital Indemnity
401(k) – up to 4% match on ROTH or Traditional contributions
Generous paid-time off and 11 paid holidays
Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo
Employee Assistance Program including no cost, in-person mental health visits and employee discounts
Monetary Anniversary Awards Program
Monetary Birthday Awards