Clinical Review Nurse (LPN)

TurningPoint Healthcare Solutions; Lake Mary (FL); Remote; USD 52,000 - 58,000; Full time

Job summary

TurningPoint Healthcare Solutions is looking for a Clinical Review Nurse (LPN) to perform clinical reviews, resolve patient care issues, and assist in quality improvement. This fully remote position requires an LPN license, customer service skills, and the ability to multi-task while maintaining excellent organizational skills.

Qualifications

• Comprehensive knowledge of general nursing theory and practices.
• Excellent customer service skills and phone etiquette.
• Previous Utilization Management experience preferred.

Responsibilities

• Perform initial clinical reviews and provide documented recommendations.
• Resolve patient care issues with community providers.
• Assist clinical staff in quality improvement projects.

Skills

Excellent customer service skills

Proficient computer skills

Ability to multi-task

Ability to work collaboratively

Education

Licensed Nurse Practitioner (LPN)

Job description

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TurningPoint Healthcare Solutions provided pay range

This range is provided by TurningPoint Healthcare Solutions. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$52,000.00/yr - $58,000.00/yr

TurningPoint Healthcare Solutions is a rapidly growing and innovative healthcare company that supports several large national health plans to improve the quality and affordability of healthcare patients receive. We are looking for motivated individuals who want to be part of our mission and join our team!

As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise and judgement along with established medical criteria to perform first level clinical review for select procedures that require medical necessity authorization. We are seeking individuals who enjoy a challenge, have an ability to work independently and are capable of meeting deadlines. Previous utilization management experience is preferred. In addition to prior experience, the ideal candidate will have an extreme attention to detail, an ability to flourish in a fast-paced environment and advanced grammar, punctuation, and computer skills. This is a fully remote position with multiple shifts available!

Responsibilities

• Perform initial clinical reviews and provide documented recommendations based on the use of appropriate clinical guidelines
• Review the initial evaluation and clinical documentation against clinical standards, applicable state regulations and relevant treatment guidelines
• Assist clinical staff in quality improvement projects to provide instructive feedback to clients and providers within scope of practice
• Resolve patient care issues by working one-on-one with community providers and staff to resolve issues in the determination process
• Provide information by responding to queries of physicians and their practice staff, sorting and distributing messages and documents, and preparing information for determinations
• Improve quality results by studying, evaluating procedures and processes and recommending changes, if needed
• Serves and protects the company by adhering to accreditation standards, professional standards, company policies and procedures, federal, state, and local requirements, and professional and licensing standards
  
  
  

Qualifications:

• Licensed Nurse Practitioner (LPN)
• Comprehensive knowledge of general nursing theory and practices
• Excellent customer service skills and phone etiquette
• Proficient computer skills, including typing and an ability to maneuver through various programs
• Previous Utilization Management experience preferred but not required
• Knowledge of musculoskeletal surgical procedures, cardiac procedures, pain management and/ or wound care is a plus
• Ability to multi-task and manage tasks to completion on a timely basis and in an organized fashion
• Ability to work collaboratively as part of a team

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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