Medical Reviewer LPN

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

Job summary

Join a purpose-driven company that empowers employees and invests in their professional development. This remote role focuses on pre-authorization reviews, ensuring optimal member benefits and evaluating medical necessity. You'll work closely with healthcare providers and members to promote effective resource use. Ideal for those with clinical experience and strong communication skills, this position offers a chance to make a meaningful impact in healthcare while enjoying comprehensive benefits and a supportive work environment.

Benefits

Health and wellness plans

401(k)

Paid time off

Parental leave

Disability insurance

Life insurance

Tuition reimbursement

Employee assistance

Paid holidays

Qualifications

• LPN with a valid, current clinical license required.
• 3+ years of clinical experience in healthcare settings.

Responsibilities

• Conduct pre-authorization reviews for medical necessity.
• Collaborate with healthcare providers and business partners.

Skills

LPN with valid clinical license

3 years clinical experience

Customer service orientation

Strong verbal and written communication

Interpersonal skills

Familiarity with PC or database systems

Willingness to travel

Education

LPN License

Tools

Medical coding (CPT/HCPCS/ICD-10)

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 use of resources. 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 operations.
• At least 3 years of clinical experience in a physician's office, hospital, or surgical setting.
• Customer service-oriented to assist internal/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 licenses as determined by management. Multi-state license fees will be provided by HCSC. Other clinical licenses do not require multi-state licensing.

Preferred Job Requirements

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

Work Schedule: Weekend and Holiday Rotation (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 plans, 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. This role may include an annual incentive bonus, subject to plan terms.

HCSC Employment Statement

We are an Equal Opportunity Employer committed to a diverse and inclusive environment. 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