LPN Case Manager Clinical Authorization

MedStar Health

  • Washington DC
  • $60,632-107,494 per year
  • Permanent
  • Full-time
  • 15 days ago
General Summary of PositionProvides support for the Care Management Department by coordinating and promoting comprehensive quality cost-effective care.*1-2 years Utilization review experience required**This role requires you to be on-site in Washington, DC, four days per week, with one remote workday each week.*Key Responsibilities
  • Assists in the identification of potential Case Management candidates through clinical review, selected diagnoses, etc., and makes appropriate referrals.
  • Contributes to the achievement of established department goals and objectives and adheres to department policies,
procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations. * Demonstrates behavior consistent with MedStar Health mission, vision, goals, objectives and patient care philosophy.
  • Identifies and reports potential coordination of benefits, subrogation, third party liability, workers compensation cases,
etc. Identifies quality, risk, or utilization issues to appropriate MedStar personnel. * Initiates contact with providers to obtain clinical information to facilitate care or pending pre-certification requests.Interacts with assigned disease management populations of limited volume. Interaction is designed to improve patient
access to care, and education regarding the disease and support services. * Maintains current knowledge of MedStar Family Choice benefits and enrollment issues in order to accurately coordinateservices. * Maintains expertise in general benefit management and serves as a resource for MedStar Family Choice members,physicians, and staff for benefit interpretation and coordination. * Maintains timely and accurate documentation in the IS System per Case Management policy.
  • Participates in meetings, work groups, etc. as assigned.
  • Processes pre-authorizations for medical necessity, LOC, covered benefits, and participation of the provider at the
discretion of the guidelines and Medical Reviewer. * Sends reviews to Medical Reviewer as appropriate. Coordinates review decisions and notifications, per policy.What We Offer
  • Culture- Collaborative, inclusive, diverse, and supportive work environment.
  • Career growth- Career mentoring to help you pursue your passions and gain skills to enhance your value.
  • Wellbeing- Competitive salary and Total Rewards benefits to help keep you happy and healthy.
  • Reputation- Regional & National recognition, advanced technology, and leading medical innovations.
Qualifications
  • 1-2 years Utilization review experience required.
  • 3-4 years Diverse clinical experience required.
  • Active DC LPN License required.
This position has a hiring range of $60,632 - $107,494

MedStar Health