Utilization Management LPN
REPORTS TO: UM Supervisor
LOCATION: Allegiance office or off-site
FSLA STATUS: Non Exempt
POSITION RESPONSIBILITIES:
The UM LPN will assist in coordinating requests for admissions and service procedures. The UM LPN is responsible for promoting the quality and cost-effectiveness of medical service and admission reviews by applying clinical judgement in accordance with medical policies and national guidelines to determine authorization/certification of said service/admission. The UM LPN ensures that all reviews are completed in a timely fashion to meet contractual requirements. This position may also include participating in team functions such as committees, QA team evaluations, and preceptorships. The incumbent is expected to conduct all communication and assignments professionally with peers, supervisors, subordinates, vendors, customers, and the public.
ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change:
รขยยข Able to initiate phone calls requesting information for admissions and continued stay reviews.
รขยยข Evaluates and authorizes the medical necessity of Services requested. utilizing, but not limited to the below criteria:
ย American Society of Addiction Medicine (ASAM)
ย MCG
ย Cigna Medical Policy
ย Plan Language
ย Internal addendum criteria
รขยยข Coordinates escalation of reviews to Medical Directors as needed.
รขยยข Screens for and initiates referrals to Case Management.
รขยยข Able to effectively initiate and return telephone messages independently.
รขยยข Provide accurate information to callers as evidenced by software entry/documentation.
รขยยข Compliance with protocols and QA requirements.
รขยยข Manage the processing of temporary provider.
รขยยข Preparation of forms, faxing, copying.
รขยยข Organizion of files and referance materials.
รขยยข Ability to operate typical office equiptment and working knowledge of basic office practices.
รขยยข Contributes to daily workflow with regular and punctual attendance.
NON-ESSENTIAL JOB FUNCTIONS:
รขยยข Performs related or other assigned duties as required or directed.
PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be met to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Sitting
80%
Reaching
Minimal
Standing
10%
Manual Dexterity
Ability to type/keyboard
Walking
10%
Telephone
High Degree
Kneeling
As needed
Computer Screen
High Degree
Bending
As needed
Lifting
25 pounds
JOB SPECIFICATIONS:
To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education, Licensure, Experience:
รขยยข Current licensure as a Licensed Practical Nurse LPN or Licensed Vocational Nurse LVN.
รขยยข At least one year clinical experience
Other Experience:
รขยยข Must possess organizational skills and the ability to prioritize multiple tasks, attention to detail and follow through to completion.
รขยยข Excellent oral and written communication skills required.
รขยยข PC skills, including Windows and Word. Ability to learn all functions of the claims processing software as is necessary for claims processing and adjudication. Must be able to adapt to software changes as they occur.
รขยยข Excellent listening skills.
รขยยข High level of interpersonal skills to work effectively with others.
รขยยข Ability to organize and recall large amounts of detailed information.
รขยยข Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations and make appropriate applications to specific situations.
รขยยข Thorough knowledge of claims processing procedures and requirements.
รขยยข Ability to project a professional image and positive attitude in any work environment.
รขยยข Ability to comply with privacy and confidentiality standards.
รขยยข Ability to be flexible, work under pressure and meet deadlines.
รขยยข Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions.
รขยยข Ability to operate typical office equipment.
รขยยข Working knowledge of general office procedures
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified.
ย Allegiance Benefit Plan Management, INC is an Equal Opportunity Employer. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: [email protected] for support.
Apply Now
LOCATION: Allegiance office or off-site
FSLA STATUS: Non Exempt
POSITION RESPONSIBILITIES:
The UM LPN will assist in coordinating requests for admissions and service procedures. The UM LPN is responsible for promoting the quality and cost-effectiveness of medical service and admission reviews by applying clinical judgement in accordance with medical policies and national guidelines to determine authorization/certification of said service/admission. The UM LPN ensures that all reviews are completed in a timely fashion to meet contractual requirements. This position may also include participating in team functions such as committees, QA team evaluations, and preceptorships. The incumbent is expected to conduct all communication and assignments professionally with peers, supervisors, subordinates, vendors, customers, and the public.
ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change:
รขยยข Able to initiate phone calls requesting information for admissions and continued stay reviews.
รขยยข Evaluates and authorizes the medical necessity of Services requested. utilizing, but not limited to the below criteria:
ย American Society of Addiction Medicine (ASAM)
ย MCG
ย Cigna Medical Policy
ย Plan Language
ย Internal addendum criteria
รขยยข Coordinates escalation of reviews to Medical Directors as needed.
รขยยข Screens for and initiates referrals to Case Management.
รขยยข Able to effectively initiate and return telephone messages independently.
รขยยข Provide accurate information to callers as evidenced by software entry/documentation.
รขยยข Compliance with protocols and QA requirements.
รขยยข Manage the processing of temporary provider.
รขยยข Preparation of forms, faxing, copying.
รขยยข Organizion of files and referance materials.
รขยยข Ability to operate typical office equiptment and working knowledge of basic office practices.
รขยยข Contributes to daily workflow with regular and punctual attendance.
NON-ESSENTIAL JOB FUNCTIONS:
รขยยข Performs related or other assigned duties as required or directed.
PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be met to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Sitting
80%
Reaching
Minimal
Standing
10%
Manual Dexterity
Ability to type/keyboard
Walking
10%
Telephone
High Degree
Kneeling
As needed
Computer Screen
High Degree
Bending
As needed
Lifting
25 pounds
JOB SPECIFICATIONS:
To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education, Licensure, Experience:
รขยยข Current licensure as a Licensed Practical Nurse LPN or Licensed Vocational Nurse LVN.
รขยยข At least one year clinical experience
Other Experience:
รขยยข Must possess organizational skills and the ability to prioritize multiple tasks, attention to detail and follow through to completion.
รขยยข Excellent oral and written communication skills required.
รขยยข PC skills, including Windows and Word. Ability to learn all functions of the claims processing software as is necessary for claims processing and adjudication. Must be able to adapt to software changes as they occur.
รขยยข Excellent listening skills.
รขยยข High level of interpersonal skills to work effectively with others.
รขยยข Ability to organize and recall large amounts of detailed information.
รขยยข Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations and make appropriate applications to specific situations.
รขยยข Thorough knowledge of claims processing procedures and requirements.
รขยยข Ability to project a professional image and positive attitude in any work environment.
รขยยข Ability to comply with privacy and confidentiality standards.
รขยยข Ability to be flexible, work under pressure and meet deadlines.
รขยยข Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions.
รขยยข Ability to operate typical office equipment.
รขยยข Working knowledge of general office procedures
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified.
ย Allegiance Benefit Plan Management, INC is an Equal Opportunity Employer. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: [email protected] for support.
Apply Now