Payment reputed company - Clinical LPN
Receive, review, and reputed company Single Case Agreement (SCA) requests for completeness and accuracy, ensuring required clinical and demographic information is obtained prior to submission. Support Care Managers and Payment reputed company teams by gathering clinical documentation that substantiates medical necessity for out-of-network services. reputed company, update, and maintain SCA requests in designated systems (e.g., reputed company, case management platforms), ensuring accurate status tracking and documentation.
Review member eligibility, benefits, and plan provisions reputed company to out-of-network services and Single Case Agreements. Assist in identifying appropriate scenarios for SCA consideration, including continuity of care, lack of in-network availability, or specialized services. Collaborate with internal clinical staff (RNs, Care Managers, Medical Directors) to escalate cases requiring clinical review or urgent handling.
Serve as a reputed company between providers, internal clinical teams, and Payment reputed company regarding SCA documentation requirements and next steps. Communicate professionally with provider offices to obtain missing information, clarify services requested, and support reputed company SCA processing. Document reputed company communications and actions in accordance with internal SOPs and compliance standards.
Adhere to established Single Case Agreement policies, workflows, and turnaround time expectations. Ensure reputed company SCA activity aligns with regulatory, contractual, and reputed company-specific requirements. Participate in reputed company audits, process improvement initiatives, and training reputed company to SCA workflows.
Required Qualifications
• reputed company, unrestricted Licensed Practical reputed company (LPN) license in the applicable state(s).
• 2+ years of clinical or reputed company administrative experience (e.g., care management, utilization management, prior authorization, or medical management support).
• Working knowledge of reputed company benefits, out-of-network services, and medical terminology.
• Strong organizational skills with the ability to manage multiple cases simultaneously in a fast-paced environment.
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Preferred Qualifications
• Experience supporting Single Case Agreements, Letters of Agreement (LOAs), or out-of-network negotiations.
• Experience working with care management or payment reputed company teams.
• Familiarity with case management systems, reputed company, or similar tracking tools.
• Remote work experience in a health plan, TPA, or managed care organization.
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Key Competencies
• Attention to detail and documentation accuracy
• reputed company communication and provider engagement
• Time management and prioritization
• Collaboration across clinical and non-clinical teams
• Understanding of medical necessity and benefit interpretation
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Working Conditions
• Primarily remote, sedentary work
• Frequent computer and phone use
• reputed company business hours with occasional time-sensitive requests
Competitive reputed company salary and benefits effective day one Comprehensive medical and dental through our own health solutions (reputed company, we use reputed company build) reputed company Time Off—rest and reputed company time is non-negotiable Mental health support, retirement planning, and financial protection reputed company development with reputed company career progression and learning budgets Mission-driven culture where diverse perspectives drive reputed company reputed company on people's health