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Job Requirements of Medical Review Nurse (LPN):
-
Employment Type:
Contractor
-
Location:
Jacksonville, FL (Onsite)
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Medical Review Nurse (LPN)
Careers Integrated Resources Inc
Jacksonville, FL (Onsite)
Contractor
Job Title: Medical Review Nurse (LPN)
Job Location: Jacksonville, FL 32246
Job Duration: 3 Months+ (Possibilities of Extension)
Job Summary:
Essential Functions:
Job Requirements:
Required Experience:
Required Education:
Required Licenses and Certifications:
Job Location: Jacksonville, FL 32246
Job Duration: 3 Months+ (Possibilities of Extension)
Job Summary:
- The Medical Review Nurse LPN reviews, authorizes, coordinates, and responds to requests for services for Client members.
- This position also communicates telephonically with providers and their offices, and occasionally with members.
- Makes decisions based on established policies and procedures, Client medical coverage guidelines, benefits, InterQual criteria, nursing knowledge.
- Refers cases to Client medical directors for potential denial.
Essential Functions:
- Review and authorize, as appropriate, phone/fax referral/authorization and clinical form requests per established criteria meeting compliance standards and timeframes.
- Review all requests not approved by the non-clinical support rep to determine benefit coverage and medical necessity.
- Review cases and potential denials with the Medical Directors.
- Research requests not clearly meeting established criteria.
- Assist the Prior Authorization non-clinical reps with the Prior Authorization process.
- Coordinate and maintain complete written documentation on all prior authorization’s requests.
- Collaborate with other Client departments, such as Claims, UM, Quality, Disputes/Appeals, and other external vendors.
- Log into phone queue to service providers.
- Answer inbound calls regarding authorizations within established time frame.
- Document contact information in electronic medical record system.
- Maintain productivity.
- Handle calls professionally.
- Provide accurate prior authorization information to provider offices.
Job Requirements:
- Knowledge of medical terminology.
- Experience with prior authorization.
- Experience applying nationally recognized criteria, including InterQual.
- Knowledge of Medicare regulations and guidelines.
- Computer skills, including ability to use Microsoft Office suite.
- Previous experience within a call-center environment.
- Ability to navigate through multiple systems and screens to resolve authorization or medical review requests.
- Talking and typing simultaneously.
- Effective time management skills.
- Effective interpersonal and communication skills.
- Ability to use electronic medical record and claims systems.
- Problem solving abilities.
- Work cooperatively, positively, and collaboratively in an interdisciplinary team.
- Work respectfully and positively with others.
- Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames.
- Ability to think analytically and make decisions.
- Ability to manage large workload.
Required Experience:
- 0-2 years related work experience.
Required Education:
- Highschool Diploma or GED.
Required Licenses and Certifications:
- LPN - Licensed Practical Nurse - State Licensure.
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