LPN Utilization Review Specialist

CHRISTUS Health; Mamou (LA); On-site; USD 48,000 - 68,000; Full time

Job summary

CHRISTUS Health in Louisiana seeks an LPN Utilization Review nurse to support clinical documentation review, determine medical necessity, and coordinate care with payors. You will apply InterQual/MCG guidelines and collaborate with the health care team to ensure approved certifications while adhering to HIPAA requirements.

Reporting to the RN supervisor, you will work 8 AM to 5 PM, Monday through Friday in a full-time role.

Qualifications

• Current LPN license issued in Louisiana.
• Current BLS certification.
• De-Esculation certification due within 90 days and recertified annually.

Responsibilities

• Review clinical documentation to determine medical necessity using nursing judgement.
• Collaborate with physicians and treatment teams to obtain supporting documentation.
• Communicate patient status changes to the interdisciplinary team.
• Maintain knowledge of regulations and HIPAA compliance.
• Coordinate certification of services with the appropriate payor.
• Attend departmental and interdepartmental meetings as scheduled.
• Apply AIDET customer service techniques in interactions.

Skills

LPN license (Louisiana)

BLS certification

Medical necessity assessments

Regulatory/compliance knowledge

Communication skills

Technology literacy

InterQual/MCG knowledge

Job description

CHRISTUS Health in Louisiana seeks an LPN Utilization Review nurse to support clinical documentation review, determine medical necessity, and coordinate care with payors. You will apply InterQual/MCG guidelines and collaborate with the health care team to ensure approved certifications while adhering to HIPAA requirements.

Reporting to the RN supervisor, you will work 8 AM to 5 PM, Monday through Friday in a full-time role.