LPN Case Manager Clinical Authorization

MedStar Health; Washington (District of Columbia); On-site; USD 45,000 - 74,000; Full time

Job summary

MedStar Health is seeking an LPN Case Manager to support the Care Management Department, coordinating quality, cost-effective care for patients. The role involves clinical review, referrals, and ensuring compliance with regulations.

Qualified candidates hold an LPN license in Maryland or DC and have utilization review experience plus diverse clinical background. Strong computer and medical knowledge are essential to coordinate benefits and communicate with providers.

Qualifications

• Knowledge of current healthcare delivery trends and utilization review criteria.
• Ability to use a computer to enter and retrieve data.
• Proficiency with Word, Excel and PowerPoint preferred.

Responsibilities

• Identify potential Case Management candidates through clinical review and referrals.
• Assist in meeting department goals while complying with policies and safety standards.
• Coordinate benefits coordination, reports, and pre-certifications as required.

Skills

Healthcare knowledge

Computer skills

Microsoft Office Proficiency

Education

LPN License (Maryland/DC)

Job description

General Summary of Position

LPN Case Manager provides support for the Care Management Department by coordinating and promoting comprehensive quality, cost-effective care.

About The Job

General Summary of Position

LPN Case Manager provides support for the Care Management Department by coordinating and promoting comprehensive quality, cost-effective care.

Primary Duties And Responsibilities

• Assists in the identification of potential Case Management candidates through clinical review selected diagnoses etc. and makes appropriate referrals.
• Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
• Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
• Identifies and reports potential coordination of benefits subrogation third party liability workers compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.
• Initiates contact with providers to obtain clinical information to facilitate care or pending pre-certification requests. Interacts with assigned disease management populations of limited volume. Interaction is designed to improve patient access to care and education regarding the disease and support services.
• Maintains current knowledge of MedStar Family Choice benefits and enrollment issues in order to accurately coordinate services.
• Maintains expertise in general benefit management and serves as a resource for MedStar Family Choice members physicians and staff for benefit interpretation and coordination.
• Maintains timely and accurate documentation in the IS System per Case Management policy.
• Participates in meetings work groups etc. as assigned.
• Processes pre-authorizations for medical necessity LOC covered benefits and participation of the provider at the discretion of the guidelines and Medical Reviewer.
• Sends reviews to Medical Reviewer as appropriate. Coordinates review decisions and notifications per policy.

Education

• Valid LPN License in the State of Maryland. required

Experience

• 1-2 years Utilization review experience required and
• 3-4 years Diverse clinical experience required

Licenses and Certifications

• LPN - Licensed Practical Nurse - State Licensure Valid LPN license in the State of Maryland or District of Columbia. Upon Hire required

Knowledge Skills And Abilities

• Knowledge of current trends in healthcare delivery and utilization review criteria.
• Ability to use computer to enter and retrieve data.
• Ability to create edit and analyze (Word Excel and PowerPoint) preferred

This position has a hiring range of

USD $32.71 - USD $53.49 /Hr.