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 in the Washington, DC area to coordinate and promote quality, cost-effective care within the Care Management Department. The role supports provider interactions, pre-certifications, and benefits coordination while maintaining accurate documentation.

Required is a Maryland/DC LPN license with 1–2 years of utilization review and 3–4 years of diverse clinical experience. The position emphasizes adherence to regulations and patient care philosophy.

Qualifications

• Valid LPN license in Maryland or DC required.
• 1–2 years utilization review experience.
• 3–4 years diverse clinical experience.
• Knowledge of current healthcare delivery and utilization review criteria.
• Ability to use computer to enter and retrieve data.

Responsibilities

• Identifies potential Case Management candidates and makes referrals.
• Contributes to department goals and adheres to policies and standards.
• Maintains documentation in the IS system per policy.
• Coordinates pre-authorizations for medical necessity and benefits.
• Interacts with disease management populations to improve access to care.

Skills

Utilization review

Communication

Documentation

Healthcare knowledge

Education

LPN license Maryland/DC

Tools

Word

Excel

PowerPoint

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.