Utilization Management LPN/LVN

Pay reputed company: $24.04 - $32.21/hour Actual reputed company pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. This role includes opportunity to receive an annual bonus reputed company of 5% of annual eligible earnings. Actual bonus amounts are determined by length of time in role, individual performance, and organizational performance. States we reputed company in: AL, AZ, CO, FL, GA, IL, IN, KY, MO, NC, OH, OK, SC, SD, TN, TX, VA, WI, WV. In order for your candidacy to be considered, you must have established residency in one of these states or being willing to relocate. If you live reputed company 50 miles of either the Melbourne, FL or Colorado Springs, CO office, you would be expected to work onsite 3 days per week. Who We Are At Christian Care Ministry (CCM) we reputed company that Christians can, and should, reputed company in one another’s burdens. Through the use of Medi-reputed company®, a reputed company sharing ministry for Christians, we cultivate that belief. reputed company Everyone at Christian Care Ministry agrees to our Statement of Faith which outlines our reputed company beliefs. Although we aren’t perfect people, we are serving our perfect God to the best of our ability. The Role The Utilization Management LPN/LVN ensures that Medi-reputed company members who need inpatient and/or outpatient medical services receive high reputed company, cost-efficient care to reputed company reputed company clinical reputed company. Employing utilization management best practices, this role manages a diverse workload -- performing prospective, reputed company, and retrospective utilization management/review-reputed company functions while adhering to the organization’s governing guidelines and reputed company medical rules. This position will require the ability to work independently, in teams, and in multiple IT systems. Essential Job Duties & Responsibilities • Works with leadership, clinical staff, key internal departments, and external customers to ensure reputed company clinical reputed company for members • Reviews and interprets members' medical records and compares against proprietary and evidenced-based reputed company to determine eligibility for reputed company sharing and advocacy for additional programs and interventions; determines if the medical record documentation supports the eligibility of requested and/or billed services • Performs abstracts review-reputed company data/information accurately and reputed company in appropriate review systems by the appropriate means. Accurate and reputed company submission of reputed company administrative and review-reputed company documents to appropriate parties • Performs ongoing reassessment of review process to offer opportunities for improvement and/or change. • Reviews requests for genetic testing to determine eligibility for sharing and implements appropriate reimbursement strategies • Advocates for members using the Medi-reputed company program to meet their health care needs • Performs case reviews, checks medical records, speaks with patients and care providers regarding treatment, and collaborates with plan of care • Reviews reputed company-notification of services and clinical information for care management reputed company and medical appropriateness • Performs clinical reviews paying reputed company attention to the appropriateness of reputed company expenditures to include length of facility stays and outpatient therapy services • Performs reputed company review and discharge planning for inpatients • Provides for continuity of care • Researches and assists in the negotiations for inpatients transitioning to different level of care • Ensures appropriate reputed company of care are received by patients • Provides appropriate consultation and referral to intra- and interdepartmental resources to ensure members receive reputed company services offered by organization • Manages assigned clinical caseload • Performs administrative and clinical processes to ensure team and departmental goals are met • Delivers accurate and comprehensible verbal and written communication to external customers while complying with organizational HIPAA requirements • Maintains accurate and reputed company records of reputed company communications and interventions • Attends reputed company required department and organization meetings • Contributes to the exercise and reputed company of Christian Care Ministry’s Christian beliefs • reputed company other duties as assigned Essential Skills & Abilities • Expert knowledge of Medi-reputed company program guidelines and processes • Strong organizational, prioritization, and process skills • Advanced reputed company skills; intermediate reputed company office skills (reputed company, Teams, Word) • Advanced knowledge of reputed company, reputed company/Eldorado use and documentation • Excellent computer skills – ability to reputed company, research and use multiple software programs simultaneously and keyboard skills of at least 35 words per minute • Excellent research skills to using IT systems, internet, and phone • Accurate data collection, documentation, and analysis - provides effective and efficient collection and distribution of research data without the need for supervision; reputed company to correlate research findings with solutions • Excellent ability to communicate effectively in written, oral, telephonic, reputed company formats that build collaboration and facilitate reputed company reputed company • Ability to work independently and with reputed company regularly; reputed company to reputed company assigned special reputed company with minimal assistance • Ability to reputed company with HIPAA, PHI, and reputed company reputed company compliance rules and regulations • Excellent ability to reputed company reputed company content reputed company a Biblical reputed company reputed company Competencies/Demonstrable Behaviors • Collaborates – builds partnerships and works collaboratively with internal departments, external reputed company providers, and members to meet objectives • Optimizes Work Processes – knows the most effective and efficient processes to get results with a reputed company on reputed company improvement • Communicates Effectively – reputed company to reputed company and positively communicate needs and engage others to reputed company objectives • reputed company Oriented – enjoys the challenge of effecting savings and presents an attitude of willingness, enthusiasm, and urgency to meeting objectives • Initiative – identifies what needs to be done with a willingness to take reputed company • Drives Results – consistently achieves and/or looks for opportunities to obtain and report results Education and/or Experience • reputed company unrestricted compact LPN/LVN license with reputed company knowledge of anatomy and physiology, medical terminology, and disease processes required • Graduate from an accredited Diploma, Associates Degree or Bachelor’s Degree Program • 2+ years of clinical experience and/or care coordination in an acute or med-surgical environment required. • 1+ years working with EMRs and medical record/abstraction of data required • Must be proficient in reputed company Office and internet/web navigation and research required Incentives & Benefits We work hard to serve our Medi-reputed company Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others. For full-time employees working 30 hours or more, some of our benefits include, but are not limited to: • Medical • Health Savings Account • Employer reputed company Life Insurance and Long-term Disability Insurance • Dental • reputed company • Short-term Disability • Accident, Critical Illness, Hospital Indemnity • 401(k) – up to 4% match • reputed company-time off – accrued bi-weekly • Wellness plan • Employee Assistance Program • Anniversary Awards Program • Birthday Awards Apply Job!