LPN Medical Review Coordinator - Certification & Data

MedWatch; Lorida (FL); Hybrid; USD 32,000 - 37,000; Full time

Job summary

MedWatch is seeking a Medical Review Coordinator to handle clinical data review, precertification decisions, and documentation in accordance with URAC standards and state requirements.

Ideal candidates have an associate degree plus 3 years nursing experience, LPN licensure, and strong MS Office skills. The role involves collaboration with medical staff and claims to ensure timely, accurate certification and patient care decisions.

Qualifications

• Associate’s degree or equivalent education and experience.
• Current unrestricted LPN license in state of practice.
• At least 3 years of clinical nursing experience.
• Strong organizational and time management skills.
• Excellent verbal and written communication skills.
• Ability to handle difficult situations tactfully and diplomatically.
• Proficient in MS Office Suite (Word, Excel, PowerPoint).

Responsibilities

• Review medical data received by mail or fax and enter into the clinical record for review by the utilization review specialist.
• Review and determine certification decisions for precertification cases; document information per MedWatch policy and notify claims office of results and follow-up needs.
• Coordinate with supervisor and Physician Advisor to obtain timely PA response within MedWatch guidelines.
• Obtain clinical information on pregnancy cases as directed by protocol.
• Discuss cases with Medical Review Specialist and forward for follow-up at delivery.
• Refer potential case management as directed to the case management supervisor.
• Obtain discharge dates and bill totals to expedite case closure and maintain records.
• Adhere to all company policies and participate in Quality Management program.
• Other duties as assigned by the Director of Utilization Review.

Skills

Organizational skills

Verbal and written communication

Tactful communication

Problem solving

Education

Associate’s degree or equivalent education

Tools

MS Office Suite (Word, Excel, PowerPoint)

Job description

MedWatch is seeking a Medical Review Coordinator to handle clinical data review, precertification decisions, and documentation in accordance with URAC standards and state requirements.

Ideal candidates have an associate degree plus 3 years nursing experience, LPN licensure, and strong MS Office skills. The role involves collaboration with medical staff and claims to ensure timely, accurate certification and patient care decisions.