LPN Utilization Review Specialist
LPN Utilization Review Specialist
Posted on :
17-07-2025
Employer Active
1 Vacancy
Job Alert
You will be updated with latest job alerts via emailValid email field required
Send jobs
Share
Send me jobs like this
Job Alert
You will be updated with latest job alerts via emailValid email field required
Send jobs
Job Description
ESSENTIAL FUNCTIONS:
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews in accordance with certification requirements of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization non-certified days (including identified causes and appeal information) discharges and quality of services as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with pre-certifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements continued stay criteria and medical necessity updates.
- Perform other functions and tasks as assigned
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Associates degree in nursing (LPN or RN) required. Bachelors or Masters degree in social work behavioral or mental health nursing or other related health field preferred.
- Two or more years experience with the population of the facility and previous experiencein utilization management preferred.
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification as required within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
- First aid may be required based on state or facility requirements.
BENEFITS:
- We have an excellent benefits package which includes medical dental vision company paid life vacation personal days sick time extended sick leave short term disability long term disability tuition reimbursement accident hospital indemnity and critical illness to name a few!
Required Experience:
Unclear Seniority
Employment Type
Full Time
Key Skills
Report This Job
Disclaimer: Drjobpro.com is only a platform that connects job seekers and employers. Applicants are advised to conduct their own independent research into the credentials of the prospective employer.We always make certain that our clients do not endorse any request for money payments, thus we advise against sharing any personal or bank-related information with any third party. If you suspect fraud or malpractice, please contact us via contact us page.
