Medical Reviewer LPN

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

Job summary

Join a purpose-driven company that values your professional growth! This remote role focuses on pre-authorization reviews, ensuring quality care and optimizing member benefits. Collaborate with healthcare providers and internal teams to evaluate medical necessity and resource use. Enjoy a supportive environment with comprehensive benefits, including health and wellness programs, paid time off, and tuition reimbursement. If you're passionate about healthcare and ready to make a difference, this position offers a rewarding career path with opportunities for development.

Benefits

Health and wellness benefits

401(k) plan

Pension plan

Paid time off

Parental leave

Disability insurance

Life insurance

Employee assistance program

Paid holidays

Tuition reimbursement

Qualifications

• 3+ years of clinical experience in a healthcare setting.
• Customer service skills to assist internal and external clients.

Responsibilities

• Conduct pre-authorization reviews for medical services and procedures.
• Collaborate with healthcare providers to optimize member benefits.

Skills

LPN with valid clinical license

Clinical experience

Customer service orientation

Strong verbal and written communication skills

Interpersonal skills

Willingness to travel

Familiarity with PC or database systems

Education

LPN License

Tools

Medical coding knowledge (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 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 operations.
• 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 licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.

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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Additional Information

If you are being referred by a connection at HCSC, ask about our Employee Referral process.

Pay Transparency Statement: At HCSC, we offer comprehensive benefits, including health and wellness, 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 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