What are the responsibilities and job description for the LPN Clinical Reviewer position at Ideal Staffing Inc.?
Fantastic North Little Rock Opportunity for an Experienced LPN Clinical Reviewer. Reviewer is responsible for the pre-certification of Plan determined procedures utilizing approved guidelines.
ESSENTIAL DUTIES AND RESPONSIBILITIES include but not limited to:
Must have Current LPN License and minimum of 3 years CLINIC nursing experience.
Monday-Friday, 8am-4:30pm! Direct Hire position!
Great Benefits & Perks!
ESSENTIAL DUTIES AND RESPONSIBILITIES include but not limited to:
- Clinical review of precertification. This includes examining plan provisions and clinical guidelines to determine if the proposed treatment is covered including chemical dependency, bariatric, and transplant services.
- Utilization and claims review including but not limited to the following claims:
- NDC number repricing
- DRG
- Case Rates
- Stop Loss
- High Dollar
- Refers cases to supervisor and/or medical director for review as necessary.
- Reviews claim investigations and miscellaneous claims for coverage determination.
- Acts as provider liaison for clinical related issues.
- Answers questions from providers and members regarding precertification and benefits.
- Reports status of ongoing tasks to supervisor.
- Administers inoculations when needed.
- Assists with provider and member outreach as requested.
- Attends staff meetings as required.
- Prepares correspondence as needed.
- Complies with the company's Cybersecurity Training Policy and HIPAA training and confidentiality requirements
- Provides support help for staff as needed.
- Regular and timely attendance required.
- Adhere to quality standards and confidentiality policies and procedures.
- Performs any other duties as required or assigned.
Must have Current LPN License and minimum of 3 years CLINIC nursing experience.
Monday-Friday, 8am-4:30pm! Direct Hire position!
Great Benefits & Perks!