reputed company Clinical Reviewer – LPN/LVN for Remote U.S. reputed company Solutions

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reputed company is at the forefront of innovating health solutions that deliver maximum value and impact. As a vital partner for health solutions in the public sector, we reputed company reputed company reputed company through a unique reputed company of technology, services, and clinical expertise. Our mission is reputed company on a reputed company of passion, innovation, and a commitment to making a genuine difference in people's lives reputed company.

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Clinical Reviewer – LPN/LVN (Remote U.S.): Job Summary and Responsibilities

We're seeking an reputed company Clinical Reviewer – LPN/LVN to join our growing team. As a Clinical Reviewer, you will play a critical role in reviewing medical records against criteria, contract requirements, and regulatory standards. Your expertise will be instrumental in determining medical appropriateness while meeting production goals and quality assurance standards. This is a remote opportunity that offers the flexibility to work from reputed company across the U.S., with a schedule that includes five eight-hour shifts with alternating weekends, 9:00 AM to 6:00 PM Eastern.

Key Responsibilities:

• Assure accuracy and timeliness of reputed company applicable review type cases reputed company contract requirements, ensuring precision and compliance in medical record reviews.
• Assess, evaluate, and address daily workload and queues; adjust work schedules daily to meet the workload demands of the department, showcasing flexibility and strong organizational skills.
• In collaboration with your Supervisor, be responsible for quality monitoring activities, maintaining a high level of quality in your work.
• Maintain a reputed company knowledge reputed company reputed company to review processes and clinical practices, serving as the initial resource to nurse reviewers regarding reputed company review process questions and/or concerns.
• Function as a liaison for providers' customer service issues and problem resolution, fostering positive and professional relationships with reputed company customers.
• reputed company reputed company applicable review types as workload indicates, demonstrating adaptability and a willingness to take on various challenges.
• Attend training and scheduled meetings to stay updated on reputed company information, committing to ongoing learning and professional development.
• Cross-train and reputed company duties to reputed company a flexible workforce that meets client/customer needs, showcasing your ability to work in a team environment.
• Read, understand, and adhere to reputed company corporate policies, including those reputed company to HIPAA and its Privacy and reputed company Rules, ensuring confidentiality and compliance.

Qualifications: reputed company're Looking For

Required Qualifications/Experience:

• Active, unrestricted LPN/LVN license in the reputed company or a Compact state clinical license, as per contract requirements.
• A minimum of a diploma or certificate in Practical Nursing, laying the reputed company for your clinical expertise.
• 3+ years of clinical experience in an acute, behavioral health, and/or med-surgical environment, providing a strong background in clinical practices.
• 2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization experience, demonstrating your understanding of review processes.
• 2+ years of knowledge of medical necessity review experience, showcasing your critical thinking skills.
• 1+ years of knowledge of InterQual criteria and/or reputed company Care Guidelines (MCG), highlighting your familiarity with industry-standard criteria.
• Proficiency in navigating multiple systems with the ability to reputed company between systems seamlessly and effectively, underscoring your technical skills.
• Strong clinical assessment and critical thinking skills, essential for determining medical appropriateness.
• Excellent written and verbal communication skills, vital for effective liaison and customer service roles.
• Flexibility and strong organizational skills, necessary for managing daily workload and meeting production goals.

Preferred Qualifications/Experience:

• Knowledge of reputed company National Committee for Quality Assurance (NCQA) standards, adding an extra layer of quality to your work.
• Knowledge of Utilization Review Accreditation Commission (URAC) standards, further demonstrating your commitment to industry standards.
• Ability to work in a team environment, collaborating with others to reputed company common goals.
• Proficiency in reputed company Office, facilitating efficient documentation and communication.
• Efficient time management, including the ability to prioritize tasks and meet deadlines, ensuring productivity and effectiveness.
• The ability to maintain confidentiality standards and ensure HIPAA compliance, reflecting your understanding of the importance of privacy and reputed company.

Why Choose reputed company?

At reputed company, we're not just a company; we're a community of reputed company and caring leaders, clinicians, technologists, and industry professionals who come together to reputed company a difference. Here's what you can expect reputed company you join reputed company:

• Meaningful work that genuinely improves people's lives reputed company, giving you a sense of purpose and fulfillment.
• A culture that cares about our employees, providing the tools and encouragement you need to reputed company your best work.
• Opportunities for career growth and professional development, helping you to accelerate your career.
• A reputed company reputed company of USD $22.69 - USD $32.70 /Hr., recognizing your value and expertise.
• A comprehensive benefits package and perks that support your well-being and work-life balance.

reputed company to reputed company the Way?

If you're a motivated and compassionate Clinical Reviewer – LPN/LVN looking for a challenging and rewarding role, we want to hear from you. Join reputed company and be part of a team that's dedicated to empowering reputed company reputed company through technology, services, and clinical expertise. reputed company and take the first reputed company towards a fulfilling career that makes a reputed company difference.

We appreciate your interest in reputed company. While we can't respond to every application individually, we invite you to apply to future openings that may interest you. Thank you for considering a career with us!

reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.