LVN- In Office
Kris Anderson Consulting, LLC - dallas, TX
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About the job LVN- In Office This position is responsible for implementing and coordinating all utilization management functions relating to pre-certification of outpatient services. The LVN Case Manager in this capacity is responsible for coordinating authorizations and workflow, direction, organization and monitoring of authorizations/utilization management. Coordinates and tracks authorization files between Authorization Coordinators and Physician reviewer. Essential Functions and Responsibilities of the Job Clear understanding of managed healthcare, utilization management Possess knowledge of applicable regulatory standards and is able to prepare for audits based upon these standards Ability to maintain compliance and turnaround time standards for all UM assignments Provide excellent customer service to our members Communicate effectively with a professional attitude. Be responsible and accountable for all assignments and deliverables Follow company policies, procedures and directives Interact in a positive and constructive manner Prioritize and multitask in a fast-paced work environment Essential Job Outcomes Inputs all information in referral system and ensures that all information is accurate. Process referral authorization from providers in a timely manner, by utilizing established protocols. Faxes back to requested provider information needed if not received. Gathers and assess relevant documentation to compare with MCG/UM Criteria. Communicates with Utilization Physician Reviewer for follow-up and resolution of authorization referrals. Interacts effectively with providers, physician reviewers, and other departments using strong verbal and written communication skills on an on-going basis Applies UM criteria appropriately to authorization requests Apply Timeliness Standards to processing of referrals (ICE Timelines Grids) Review and update authorizations as needed Requests medical records or other information as needed to justify referrals Other duties as assigned
Created: 2024-07-07