Remote LPN Utilization Reviewer – Home Health

Coastal Care Services, Inc.; Miami (FL); Remote; USD 32,000 - 45,000; Full time

Benefits offered by this job

Dental insurance

Disability insurance

Employee discount

Health insurance

Life insurance

Paid time off

Vision insurance

Job summary

Coastal Care Services, Inc. is seeking an LPN licensed Utilization Management Nurse Reviewer for a work-from-home opportunity serving the Miami, FL area.

Work schedule is 10am to 7pm, with every other Sunday and a weekday off for a total of five days per week. The role manages treatment plans and utilization for Home Health Care, Infusion Services, and Durable Medical Equipment, reviews medical necessity, collaborates with physicians, patients and families to assure cost-effective, high-quality

Qualifications

• LPN license required.
• 2+ years of Home Health Managed Care experience preferred.
• Experience with Medicare/Medicaid Managed Care.
• Familiarity with InterQual/MCG or other medical-necessity criteria.
• Excellent customer service and communication skills.
• Bilingual English/Spanish preferred.
• Proficient with MS Outlook, Word and internet research.
• Work-at-home requirements: reliable high-speed internet and private workspace.

Responsibilities

• Manage treatment plans and utilization for Home Health/Infusion/DME patients.
• Conduct reviews to determine medical necessity and appropriateness.
• Coordinate with physicians, patients and families to ensure quality, cost-effective home care.
• Authorize and communicate care plans and changes in a timely manner.
• Maintain patient lists and document rationale for care decisions.

Skills

LPN license

Home Health Managed Care

Medicare/Medicaid Managed Care

InterQual/MCG criteria

Customer service

Bilingual (English/Spanish)

MS Outlook

Work from home setup

Education

High school diploma or equivalent

Tools

InterQual

Milliman Care Guidelines

Job description

Coastal Care Services, Inc. is seeking an LPN licensed Utilization Management Nurse Reviewer for a work-from-home opportunity serving the Miami, FL area.

Work schedule is 10am to 7pm, with every other Sunday and a weekday off for a total of five days per week. The role manages treatment plans and utilization for Home Health Care, Infusion Services, and Durable Medical Equipment, reviews medical necessity, collaborates with physicians, patients and families to assure cost-effective, high-quality