Remote LPN Utilization Review Coordinator

MaziCTools; United States; Remote; CAD 77,000 - 98,000; Full time

Job summary

MedWatch LLC is seeking a Remote Utilization Review Coordinator licensed practical nurse (LPN) to perform review and certification duties. The role requires an unrestricted LPN license and at least three years of clinical nursing experience.

Responsibilities include data review, certification decisions, and coordination with physicians and claims offices. The position operates remotely and adheres to MedWatch procedures and URAC standards.

Qualifications

• Licensed Practical Nurse (current unrestricted, in state of practice).
• 2-year degree, L.P.N.
• 3 years clinical nursing experience.

Responsibilities

• Review medical data obtained by mail or fax and enter into the clinical record for review by the utilization review specialist.
• Review and determine certification decision for all precertification cases forwarded to her by the utilization review specialist. Document all information obtained according to MedWatch policy.
• Follow- up post procedure to obtain the pathology report as appropriate and send a notification memo to the claims office advising of the results and any additional treatment needed.
• Discuss all cases lacking clinical information to allow certification with her supervisor prior to sending to the appropriate Physician Advisor for review.
• Follow up to assure PA response timely within MedWatch guidelines.
• Obtain clinical information on all pregnancy cases as directed by MedWatch protocol.
• Discuss any case with the Medical Review Specialist which may include high risk OB clinical and memo the claims office information obtained. Forward the case to the assigned utilization review specialist for follow-up at the time of delivery.
• At the direction of the Medical Review Specialist, discuss potential case management referrals with the case management supervisor and refer as directed to the claims office.
• Obtain discharge dates and bill totals for the Medical Review Specialist at the time of discharge to expedite closure of cases.
• Adhere to all company policies as stated in the employee handbook.
• Assist with projects as directed by the Director of Utilization Management.
• Participate in the Quality Management Program by adhering to all company policies and procedures and identifying opportunities for improvement to ensure quality services are rendered to clients and customers.

Education

2-year degree, L.P.N.

Job description

MedWatch LLC is seeking a Remote Utilization Review Coordinator licensed practical nurse (LPN) to perform review and certification duties. The role requires an unrestricted LPN license and at least three years of clinical nursing experience.

Responsibilities include data review, certification decisions, and coordination with physicians and claims offices. The position operates remotely and adheres to MedWatch procedures and URAC standards.