Clinical Utilization & Care Advocate

WestCare Inc; Henderson (NV); On-site; USD 33,000 - 34,000; Full time

Job summary

WestCare Inc. in Henderson, NV is seeking a full-time professional to coordinate clinical information with MCOs and advocate for appropriate levels of care for patients.

This role requires strong knowledge of CPT/ICD coding, HIPAA compliance, and utilization review processes. The candidate should have an LPN/RN credential (Associate or Bachelor) and/or CADC/LADC with at least two years of utilization review experience, with proficiency in EMR/CDS systems and Microsoft Office.

Qualifications

• Associates or Bachelors level LPN or RN and/or CADC/LADC with 2 years utilization review experience.

Responsibilities

• Establish communication with insurance carriers and advocate for patient care.
• Review patient charts and case notes to determine appropriate levels of care.
• Submit and track authorization documentation with payors.

Skills

Communication

Documentation

Collaboration

Critical thinking

HIPAA knowledge

Education

Associates/Bachelors LPN/RN and CADC/LADC+2 yrs utilization review

Tools

EMR/CDS Systems

Microsoft Office

Job description

WestCare Inc. in Henderson, NV is seeking a full-time professional to coordinate clinical information with MCOs and advocate for appropriate levels of care for patients.

This role requires strong knowledge of CPT/ICD coding, HIPAA compliance, and utilization review processes. The candidate should have an LPN/RN credential (Associate or Bachelor) and/or CADC/LADC with at least two years of utilization review experience, with proficiency in EMR/CDS systems and Microsoft Office.