Medical Necessity Reviewer

1 week ago


Hattiesburg, Mississippi, United States Forrest General Hospital Full time
Job Summary

We are seeking a highly skilled Licensed Practical Nurse (LPN) to join our team as a Medical Necessity Reviewer. In this role, you will be responsible for performing concurrent and retrospective reviews of patient cases to ensure medical necessity for admission and continued stay.

Key Responsibilities:
  • Conduct thorough reviews of patient records to assess medical necessity for admission and continued stay
  • Collaborate with attending physicians and UM physician advisors to discuss cases that do not meet medical necessity criteria
  • Monitor observation cases daily and ensure timely reviews and notification to insurance payers
  • Compile clinical information needed to process prior authorization and continued stay requests
  • Document all relative information in the electronic medical record
Requirements:
  • Graduate of an accredited licensed practical nursing program
  • Licensed LPN able to practice within the State of MS
  • Exceptional oral and written communication skills
  • Ability to type and use a personal computer
  • Workable knowledge of DNV standards, correct coding procedures, InterQual Level of Care criteria, Milliman Care Guidelines (MCG), Perspective Payment System, and medical terminology
Salary Information:

$65,000 - $85,000 per year, depending on experience

About Us:

We are proud to be part of Forrest General Hospital, a leading healthcare provider in Mississippi. Our team is dedicated to delivering exceptional patient care and service.



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