Medical Reviewer LPN

Health Care Service Corporation; Chicago (IL); Remote; USD 45,000 - 101,000; Full time

Job summary

Join a purpose-driven company that values employee development and offers a fulfilling career in healthcare. This remote role focuses on pre-authorization reviews, collaborating with healthcare providers to ensure quality care and optimize member benefits. You'll play a vital role in evaluating medical necessity for various services while being part of a supportive team. With a commitment to employee growth and comprehensive benefits, this opportunity is perfect for those looking to make a meaningful impact in the healthcare industry.

Benefits

Health and wellness programs

401(k)

Pension

Paid time off

Parental leave

Disability insurance

Life insurance

Employee assistance

Paid holidays

Tuition reimbursement

Qualifications

• Must have a valid, unrestricted LPN license in the state of operation.
• 3+ years of clinical experience in a healthcare setting.

Responsibilities

• Conduct pre-authorization reviews per medical criteria and regulations.
• Collaborate with healthcare providers and members to optimize benefits.

Skills

Clinical experience

Customer service orientation

Verbal communication skills

Written communication skills

Interpersonal skills

Organizational skills

Planning skills

Familiarity with PC or database systems

Education

LPN License

Job description

At HCSC, our employees are the cornerstone of our business and the foundation of our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that invests in your professional development.

Job Summary

This position is responsible for pre-authorization reviews in accordance with the medical contract, regulations, medical criteria, utilization review, and quality of care. The role involves collaborating with healthcare providers, members, and business partners to optimize member benefits, evaluate medical necessity, and promote effective resource use. Medical necessity reviews may include inpatient admissions, outpatient services, surgical and diagnostic procedures, home health, durable medical equipment, and out-of-network services.

Job Requirements

• LPN with a valid, current, unrestricted clinical license in the state of operation.
• At least 3 years of clinical experience in a physician's office, hospital, or surgical setting.
• Customer service orientation to assist internal and external customers.
• Strong verbal and written communication skills.
• Interpersonal skills and ability to work as part of a team.
• Willingness and ability to travel.
• Familiarity with PC or database systems.
• Incumbents with nursing licenses in multi-state positions are required to obtain and maintain additional current, valid, and unrestricted licenses in other states as determined by management. Multi-state license fees will be covered by HCSC. Other clinical licenses do not require multi-state licensing.

Preferred Job Requirements

• Multi-state License for LPN / LVN (preferred)
• Experience in utilization review or utilization management
• Strong organizational, planning, and communication skills
• Knowledge of the insurance industry, medical coding (CPT/HCPCS/ICD-10)
• Familiarity with National and Local Coverage Determinations and MCG criteria is a plus.

Work Schedule: Weekend and Holiday rotations (2 holidays per year).

This is a remote role: Must reside within 250 miles of the office or within the posted state.

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Pay Transparency Statement: At HCSC, we offer comprehensive benefits including health and wellness programs, 401(k), pension, paid time off, parental leave, disability insurance, life insurance, employee assistance, paid holidays, tuition reimbursement, and more. Learn more at https://careers.hcsc.com/totalrewards. Compensation varies based on skills, education, and experience, and may include an annual incentive bonus.

HCSC is an Equal Opportunity Employer committed to a diverse and inclusive workplace. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Base Pay Range: $45,000.00 - $100,100.00