Licensed Vocational Nurse (LVN) - RC Precert Clinician

Conifer Health Solutions; El Paso (TX); On-site; USD 65,000 - 85,000; Full time

Job summary

Conifer Health Solutions is seeking a Revenue Cycle Management Clinician for Pre-Authorization at THOP Memorial Campus. The role handles pre-authorization reviews for inpatient and outpatient services, coordinating with physicians and facility staff to secure approvals according to payer criteria.

Spanish bilingual required and nursing licensure is required. The position emphasizes collaboration with care teams, adherence to payer guidelines, and contribution to quality initiatives within a

Qualifications

• Must possess a valid nursing license (RN/LPN/LVN); LPN or RN preferred.
• 3–5 years in pre-authorization or utilization review in payer or acute care.
• Spanish bilingual required; able to communicate with diverse patients and providers.

Responsibilities

• Performs pre-service authorization reviews to obtain payment authorization for inpatient and outpatient services; abstracts fact-based clinical information to support medical necessity and documents outcomes.
• Supports quality management with audits and projects to improve Conifer and client metrics; provides feedback for workflow improvements.
• Demonstrates proficiency in the use of multiple electronic tools required by Conifer and its clients.
• Collaborates with facility staff and physicians to prevent disputes by identifying gaps and suggesting solutions to CAS leadership.
• Other duties as assigned.

Skills

Nursing license

Spanish bilingual

Electronic tools proficiency

Education

RN/LPN/LVN licensure (preferred)

CPUR/CPUM/CPHM or CCM certification (preferred)

Tools

Electronic health record systems

Job description

JOB SUMMARY

The Revenue Cycle Management Clinician for the Pre-Authorization Solution is responsible for:

• All clinical pre-authorization activities associated with patients financially cleared through the Patient Access Support Unit (PASU) and/or the Center for Patient Access Services (CPAS).
• Coordinating with ordering physicians and/or facility staff to secure the necessary prior payment authorization utilizing applicable payer criteria.

Working Location: THOP Memorial Campus

Spanish Bilingual Required

Essential Duties And Responsibilities

• Performs pre-service authorization reviews to obtain payment authorization for both inpatient and outpatient services. Succinctly abstracts fact based clinical information to support pre-authorization utilizing applicable nationally recognized and payer-specific criteria; communicates timely the clinical information supporting the medical necessity of an ordered test/treatment/procedure/surgery as applicable to the patient’s health plan and documents the outcome of the task.
• Performs the following activities to support the effective operation of the organization’s quality management system. A minimum of 2.5 % of time is spent carrying out the following responsibilities: Participation in quality control audit process; participation in department projects and activities to improve overall Conifer and client scorecard metrics. provides feedback regarding improvement opportunities for workflow &/or procedures; and the contributes to successful implementation of all the above.
• Demonstrates proficiency in the use of multiple electronic tools required by both Conifer and its clients.
• Collaborate with and engage internal and external customers, such as facility patient access and physician offices, in opportunities for prevention of future disputes; identifies potential process gaps and recommends sound solutions to CAS leadership.
• Other duties as assigned.

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

Education / Experience

• Must possess a valid nursing license (Registered or Practical/Vocational). LPN or RN PREFERRED.
• Minimum of 3-5 years as a pre-authorization or utilization review nurse in a payer or acute care setting; preferably medical-surgical or critical care/ED

CERTIFICATES, LICENSES, REGISTRATIONS

• Current, valid RN/LPN/LVN licensure
• Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) or Certified Case Manager (CCM) preferred

PHYSICAL DEMANDS

• Ability to lift 15-20lbs
• Ability to travel approximately 10% of the time; either to client &/or Conifer office sites
• Ability to sit and work at a computer for a prolonged period of time conducting pre-service medical necessity reviews

WORK ENVIRONMENT

• Characteristic of typical Call Center environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.

Other

• May require travel – approximately 10%
• Interaction with staff at client facilities such as and not limited to Patient Access, Case management, physicians and/or their office staff is a requirement.

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.

Tenet participates in the E-Verify program. Follow the link below for additional information.

E-Verify: http://www.uscis.gov/e-verify

The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.

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Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.