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Medical Reviewer LVN

2 months ago

Richardson, Texas, United States HCSC Full time

About HCSC

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

We are a purpose-driven company that invests in our employees' professional development, providing them with the tools and resources needed to excel in their roles.

Job Summary

This position is responsible for performing discharge care coordination and review activities to determine the efficiency, effectiveness, and quality of medical/surgical services. The successful candidate will serve as a liaison between providers and medical and network management divisions.

Key Responsibilities

  • Review service requests and collect clinical and non-clinical data to verify eligibility and determine benefit levels in accordance with contract guidelines.
  • Conduct initial and concurrent reviews to prepare reports on the quality of care and identify and report cases.
  • Provide information regarding utilization management requirements and operational procedures to members, providers, and facilities.
  • Travel to various locations as needed.

Requirements

  • Valid, current, unrestricted LVN license in the state of operations.
  • 3 years of clinical experience in a physician office, hospital, or surgical setting.
  • Excellent customer service skills to assist internal and external customers.
  • Knowledge of medical terminology and procedures.
  • Verbal and written communication skills.
  • Interpersonal skills and ability to work as a team player.
  • Familiarity with PC or database systems.
  • Ability to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management.

Preferred Requirements

  • Utilization review or utilization management experience.
  • MCG Certification.

HCSC Employment Statement

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.