Utilization Reviewer (LPN)

Utilization Reviewer (LPN)

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Are you an experienced LPN looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Daily Responsibilities:

The Utilization Review LPN is responsible for the pre-certification of determined procedures utilizing the organizations Plan approved criteria. The position helps manage healthcare costs by influencing patient care decision making through case-by-case assessments of the care prior to it’s delivery.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Evaluates requested services following Plan approved criteria.
• Demonstrates effective communication methods and skills, using lines of authority appropriately.
• Establishes a relationship with providers in order to determine/provide needed services for members
• Arranges discharge planning services prior to pre-planned admissions when available.
• Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
• Maintains accurate record of pre-certification decisions.
• Performs decisions within time frames required by regulatory agencies.
• Adheres to quality standards and confidentiality policies and procedures.
• Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
• Adapts to changes in policies, procedures, new techniques and additional responsibilities.

Qualifications

Active FL LPN license with a minimum of 2 years varied clinical experience required.

Managed Care experience (utilization review, pre-certification, concurrent review) is preferred.

Proficiency in MS Office with basic computer and typing skills.

Additional Information

Advantages of this Opportunity:

• Competitive salary $19 - $26/hr+ (based off experience)

• Excellent Medical Benefits Offered

• Growth potential

• Fun and positive work environment

If you are interested in applying to this position please call Jonathan Comstock at (407) 478-0332 Ext. 133