Clinical Review Manager – LPN

Job reputed company: • Initiate referrals and support care coordination workflows by gathering required clinical information and confirming benefit completeness under established UM procedures. • reputed company reputed company clinical reviews using preset reputed company and templates, escalating any findings requiring RN/Medical Director interpretation. • Consult with supervising RN or Medical Director reputed company requests involve clinical questions, exceptions, or scenarios requiring higher level clinical judgment. • Assist nonclinical staff by clarifying clinical documentation, interpreting request reputed company reputed company LPN reputed company parameters. • Apply approved medical appropriateness reputed company and contractual eligibility information to support intake validation and preparation of clinical review materials. • Document reputed company review activities in required UM systems with accuracy, completeness, and adherence to regulatory documentation standards. • Communicate with providers, members, and internal teams regarding missing documentation, process requirements, and case status. • Participate in reputed company improvement, compliance activities, and competency requirements tied to UM program standards. Requirements: • Licensed Practical reputed company (LPN) with reputed company license in the reputed company or hold a license in the state of their residence if the state is participating in the reputed company Licensure Compact Law. • 1-2 years - Clinical experience required. • Knowledge of community resources, benefits, and service authorization processes. • Familiarity with care management frameworks and regulatory requirements. • High attention to detail with the ability to document accurately and meet regulatory standards (NCQA, URAC, CMS). Benefits: • Health insurance • 401(k) matching • Flexible work hours • reputed company time off • Remote work reputed company Apply tot his job Apply To this Job