LPN Medical Review Coordinator — Utilization & Case Review

MedWatch; Tallahassee (FL); Remote; USD 32,000 - 37,000; Full time

Job summary

MedWatch is seeking a Medical Review Coordinator in Tallahassee. The role requires an LPN with an active, unrestricted license in the state of practice and at least 3 years of clinical nursing experience.

You will review medical data, document certification decisions, and coordinate with physicians and the claims office to ensure timely approvals. Proficiency in MS Office and strong verbal and written communication skills are essential as you navigate URAC standards and MedWatch policies in a

Qualifications

• Must have an Associate's degree or equivalent education and experience.
• Licensed Practical Nurse with current unrestricted license in-state.
• 3 years of clinical nursing experience.
• Strong organizational and time-management skills.
• Excellent verbal and written communication skills.
• 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.
• Determine certification decisions for precertification cases and document information per MedWatch policy.
• Coordinate with supervisor and Physician Advisor to obtain timely PA responses and required information.
• Obtain clinical information for pregnancy cases as directed by MedWatch protocol.
• Communicate findings to claims office and pursue necessary follow-ups.
• Refer potential case management needs to case management and claims offices as directed.
• Obtain discharge dates and bill totals to expedite case closure.
• Adhere to all MedWatch policies and participate in quality improvement initiatives.

Skills

Org & time mgmt

Verbal & written comms

Difficult situations tactful

Problem solving & decision-making

MS Office proficiency

Education

Associate's degree or equivalent education and experience

Job description

MedWatch is seeking a Medical Review Coordinator in Tallahassee. The role requires an LPN with an active, unrestricted license in the state of practice and at least 3 years of clinical nursing experience.

You will review medical data, document certification decisions, and coordinate with physicians and the claims office to ensure timely approvals. Proficiency in MS Office and strong verbal and written communication skills are essential as you navigate URAC standards and MedWatch policies in a