LPN - Case Manager - Monroe
1 day ago
This role coordinates, negotiates, procures, and manages the care of complex patients to facilitate achievement of quality and cost outcomes for admission to the facility, diagnostic procedures, or clinical specialties. Serves as a resource for physician and multi-disciplinary team members to obtain information regarding current charges, reimbursement, and payor source limitations.
Key Responsibilities- Performs pre-admission, admission, and continued stay reviews as directed per content management system (CMS) or commercial payer guidelines and/or hospital policy.
- Collaborates with hospital staff, as required, for authorization/certification processes.
- Explores strategies to reduce length of stay and resource consumption for case managed patient populations.
- Identifies appropriate patients for the various third-party payor pre-certification or pre-authorization process.
- Adapts behavior to the specific patient population, including but not limited to respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions, and communication style.
- Performs other related duties as required.
- Graduate of an accredited licensed practical nurse (LPN) program.
- 3 years of hospital-based experience.
- Preferred experience in utilization review.
- Current licensed practical nurse (LPN) license in the state of practice.
- Working knowledge of admission criteria, including International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes, and Medical Necessity guidelines.
- Computer skills and dexterity for data entry and retrieval of information.
- Effective verbal and written communication skills and ability to present information clearly and professionally.
- Proficient with Windows-style applications, various software packages specific to role, and keyboard.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work.
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