Remote LPN Utilization Review Specialist

Mass Digital Health; Quincy (MA); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Comprehensive medical, dental, and vision plans

Paid time off and family leave

401(k) plan with company match

Education assistance

Job summary

Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical reviews based on patient eligibility and contract requirements, requiring clinical expertise and knowledge of Medicaid guidelines.

Candidates must have an active LPN license, at least one year of experience in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including medical, dental, and 401(k) plans.

Qualifications

• Must have an active LPN/LVN license in good standing.
• Minimum of one year experience reviewing medical records.
• Experience working in a remote setting.

Responsibilities

• Perform retrospective review of medical records for medical necessity.
• Submit authorization requests based on state deadlines.
• Assist in the orientation and training of new clinical staff.

Skills

Clinical expertise

Reviewing medical records

Medicaid guidelines knowledge

Denials and appeals handling

Remote work capability

Education

Licensed Practical/Vocational Nurse Program (LPN)

Job description

Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical reviews based on patient eligibility and contract requirements, requiring clinical expertise and knowledge of Medicaid guidelines.

Candidates must have an active LPN license, at least one year of experience in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including medical, dental, and 401(k) plans.