LVN Post Service Review Coordinator (Jobs - Full Time Jobs)

Ad ID 533680 in Category: Jobs - Full Time Jobs

LVN Post Service Review Coordinator
If you have the desire to do more, experience new things, expand your knowledge and abilities, and develop an incredible career, you can do it all here in a friendly, high-energy, business-casual work environment. This is an excellent opportunity with one of the top 10 best Managed Care companies in the country for a top notch LVN Post Service Review Coordinator in the Woodland Hills, CA area. Position Description: - The LVN Post Service Review Coordinator performs advanced and complicated case review and first level determination approvals for inpatient, outpatient and ancillary service requests, medical necessity appeals or claim review requests including high dollar claims after the delivery of services. - The position will provide preliminary research for the Medical Review Unit Clinical Staff according to current established policies and procedures, as well as AMA CPT and CMS guidelines. - Case reviews include determination of medical appropriateness and medical necessity requiring considerable clinical judgment, independent analysis, critical-thinking skills and detailed knowledge of departmental procedures, clinical guidelines and coding conventions. - Acts as a liaison between medical management network management, claims, member services and other departments to resolve retrospective review issues. Requirements: - Valid/Clear state of California LVN (Licensed Vocational Nurse) license. Experience: - Minimum two years of prior clinical acute care experience. - One year of managed care experience with an emphasis on claims review, medical coding or utilization/case management or retrospective review. - Knowledge of InterQual, Medi-Cal, Lotus, MS Word, Excel, and Explorer. - Experience using standardized clinical guidelines/criteria and with medical coding. In return for your expertise, we offer a professional and team atmosphere, great work environment, excellent weekly pay, and other kudos. No holidays or on-call hours! Keywords: Case Manager, Care Manager, CM, RN, QM, UR, UM, Appeals and Grievances, Quality Management, Utilization Review, Concurrent Review, Managed Care, Insurance, HMO, PPO, IPA, CCM, RN, Nurse Practitioner, Registered Nurse, Medical and Clinical Review, Retrospective Review, Prior Authorizations, Discharge Planning, Medical Records Abstractor.
Related Link: Click Here (0 hit) Target State: California (California Classifieds) Target City : Woodland Hills Last Update : Aug 04, 2008 06:37:41 PM CDT	Ad Owner Name: Salvador Contact Phone: 818-716-6330 Contact Email: 148t@kellyservices.com Number of Views: 54

Visitor Comments

No visitor comment on this ad (ID 533680).

Click here to make your comment on this ad.