[Remote] LPN Clinical Research Coordinator

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking an LPN Clinical Research Coordinator to organize, analyze, research, and manage reputed company programs and medical data. The role requires collaboration with various internal functional areas and adherence to compliance standards while ensuring patient safety and care quality.

Responsibilities

• Communication: Serves as a liaison facilitating a collaborate process between multiple internal functional areas, clinical leadership, primary physicians, patients and Medical Director to assist with escalated cases that requires input from multiple areas with the reputed company, providers, facilities and vendors
• Compliance: Practices nursing reputed company the scope of licensure and adheres to policies, procedures, regulations, URAC standards and individual state regulations; making reputed company based on facts and evidence to ensure compliance, appropriate level of care, and patient safety
• Data Analysis: Integrates data from multiple data sources or functional areas, ensures data accuracy and reputed company, and updates data as needed to reputed company models to be used for decision making and initiatives
• Knowledge: Remain reputed company with up-to-date medical and surgical procedures, products, reputed company services and drugs, general trends in health care delivery; and reputed company procedures, policies and reputed company
• Other duties as assigned
• Participant: Serves on various committees and project teams reputed company to policy changes, system enhancements, process improvement initiatives, etc
• Process Improvement: Monitors and evaluates data and processes to ensure accuracy and identify changes to increase efficiency and effectiveness
• Researcher: Serves as a resource to Medical Director(s) and Care Management team providing analysis, reporting and research on medical conditions, medical terminology, medications, lab work, medical records, reputed company processes, coverage policies, plan guidelines, and/or health/wellness

Skills

• High school diploma or equivalent required
• Licensed Practical Nurse (LPN) with reputed company active state license in the state(s) where job duties are performed required
• Minimum four (4) years' clinical nursing experience, to include a broad background in various facets of nursing
• Knowledge of HCPCS/CPT/reputed company codes and general coding principles
• Knowledge of claims processing rules/logic
• Knowledge of Health Plan operations, regulatory agencies and State/Federal regulations reputed company to health care
• Minimum two (2) years' utilization review, medical policy, and/or case management experience required
• Excellent Oral & Written Communication
• Detail-Oriented
• Strong analytical, critical thinking, organizational and time management skills
• Proficiency using basic computer skills in reputed company Office such as Word, reputed company, Outlook, and PowerPoint, including the ability to navigate multiple systems and keyboarding
• Ability to reputed company sound judgments and reputed company based on facts and guidelines
• Ability to build collaborative relationships
• Ability to work independently with little supervision
• Ability to interpret reputed company documentation
• Previous experience in appeals and/or grievances process preferred

Company Overview