Medical Review Nurse (LPN)
Our Client, a Mutual Insurance Holding Company, is looking for Medical Review Nurse (LPN) for their Remote location
Responsibilities:
The Medical Review Nurse LPN reviews, authorizes, coordinates, and responds to requests for services for Florida Blue members.
This position also communicates telephonically with providers and their offices, and occasionally with members.
Makes decisions based on established policies and procedures, Florida Blue medical coverage guidelines, benefits, InterQual criteria, nursing knowledge.
Refers cases to Florida Blue medical directors for potential denial.
Review and authorize, as appropriate, phone/fax referral/authorization and clinical form requests per established criteria meeting compliance standards and timeframes
Review all requests not approved by the non-clinical support rep to determine benefit coverage and medical necessity
Review cases and potential denials with the Medical Directors
Research requests not clearly meeting established criteria
Assist the Prior Authorization non-clinical reps with the Prior Authorization process
Coordinate and maintain complete written documentation on all prior authorizations requests.
Collaborate with other Florida Blue departments, such as Claims, UM, Quality, Disputes/Appeals, and other external vendors.
Log into phone queue to service providers
Answer inbound calls regarding authorizations within established time frame
Document contact information in electronic medical record system
Maintain productivity
Handle calls professionally
Provide accurate prior authorization information to provider offices
Requirements
Knowledge of medical terminology
Experience with prior authorization
Experience applying nationally recognized criteria, including InterQual
Knowledge of Medicare regulations and guidelines
Computer skills, including ability to use Microsoft Office suite
Previous experience within a call-center environment
Ability to navigate through multiple systems and screens to resolve authorization or medical review requests
Talking and typing simultaneously
Effective time management skills
Effective interpersonal and communication skills
Ability to use electronic medical record and claims systems
Problem solving abilities
Work cooperatively, positively, and collaboratively in an interdisciplinary team
Work respectfully and positively with others
Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames
Ability to think analytically and make decisions
Ability to manage large workload
0-2 years related work experience
Highschool Diploma or GED
LPN - Licensed Practical Nurse - State Licensure
Why Should You Apply?
Health Benefits
Referral Program
Excellent growth and advancement opportunities
As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
Apply Now
Responsibilities:
The Medical Review Nurse LPN reviews, authorizes, coordinates, and responds to requests for services for Florida Blue members.
This position also communicates telephonically with providers and their offices, and occasionally with members.
Makes decisions based on established policies and procedures, Florida Blue medical coverage guidelines, benefits, InterQual criteria, nursing knowledge.
Refers cases to Florida Blue medical directors for potential denial.
Review and authorize, as appropriate, phone/fax referral/authorization and clinical form requests per established criteria meeting compliance standards and timeframes
Review all requests not approved by the non-clinical support rep to determine benefit coverage and medical necessity
Review cases and potential denials with the Medical Directors
Research requests not clearly meeting established criteria
Assist the Prior Authorization non-clinical reps with the Prior Authorization process
Coordinate and maintain complete written documentation on all prior authorizations requests.
Collaborate with other Florida Blue departments, such as Claims, UM, Quality, Disputes/Appeals, and other external vendors.
Log into phone queue to service providers
Answer inbound calls regarding authorizations within established time frame
Document contact information in electronic medical record system
Maintain productivity
Handle calls professionally
Provide accurate prior authorization information to provider offices
Requirements
Knowledge of medical terminology
Experience with prior authorization
Experience applying nationally recognized criteria, including InterQual
Knowledge of Medicare regulations and guidelines
Computer skills, including ability to use Microsoft Office suite
Previous experience within a call-center environment
Ability to navigate through multiple systems and screens to resolve authorization or medical review requests
Talking and typing simultaneously
Effective time management skills
Effective interpersonal and communication skills
Ability to use electronic medical record and claims systems
Problem solving abilities
Work cooperatively, positively, and collaboratively in an interdisciplinary team
Work respectfully and positively with others
Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames
Ability to think analytically and make decisions
Ability to manage large workload
0-2 years related work experience
Highschool Diploma or GED
LPN - Licensed Practical Nurse - State Licensure
Why Should You Apply?
Health Benefits
Referral Program
Excellent growth and advancement opportunities
As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
Apply Now