LPN Care Review Clinician I (68301)
Company: Professional Management Enterprises
Location: New York
Posted on: March 13, 2025
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Job Description:
Job Description:
All UM standard/ expedited Inpatient, Outpatient and Custodial Care
clinical reviews for MLTC members. MUST be a NY State License
Practical Nurse (LPN). This position is FULLY REMOTE. Schedule M-F
8:30am-5:00pm EST.
Must Have Skills:
Must have experience in UM, experience with Turnaround Timeframes,
good with computer systems and be able to learn a new system, have
done clinical reviews and processed denials and partial denial
determinations, know MCG and can use it, case presentation for
medical reviews, know Medicaid/ Medicare guidelines. Bi-lingual in
any language is preferred but not mandatory
Day to Day Responsibilities:
All UM standard Inpatient, Outpatient and Custodial Care processes
and workflows for any requests, verbal notifications for
denials/partial denials to both member and provider, participation
in IDTs, personal queue management and clinical reviews, meeting
expected productivity and performance Productivity expectations are
set a by Enterprise Clinical Services based on the local HP time
studied performance. Standard full capacity and performance reviews
expectations is 30 cases a day.
Required Years of Experience:
At least 1-2 years' experience in UM.
Required Licensure / Education:
Licensure required is a NY State License Practical Nurse -LPN
NY
Job Description:
All UM standard/ expedited Inpatient, Outpatient and Custodial Care
clinical reviews for MLTC members. MUST be a NY State License
Practical Nurse (LPN). This position is FULLY REMOTE. Schedule M-F
8:30am-5:00pm EST.
Must Have Skills:
Must have experience in UM, experience with Turnaround Timeframes,
good with computer systems and be able to learn a new system, have
done clinical reviews and processed denials and partial denial
determinations, know MCG and can use it, case presentation for
medical reviews, know Medicaid/ Medicare guidelines. Bi-lingual in
any language is preferred but not mandatory
Day to Day Responsibilities:
All UM standard Inpatient, Outpatient and Custodial Care processes
and workflows for any requests, verbal notifications for
denials/partial denials to both member and provider, participation
in IDTs, personal queue management and clinical reviews, meeting
expected productivity and performance Productivity expectations are
set a by Enterprise Clinical Services based on the local HP time
studied performance. Standard full capacity and performance reviews
expectations is 30 cases a day.
Required Years of Experience:
At least 1-2 years' experience in UM.
Required Licensure / Education:
Licensure required is a NY State License Practical Nurse -LPN
NY
Keywords: Professional Management Enterprises, New York , LPN Care Review Clinician I (68301), Healthcare , New York, New York
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