Medical Reviewer LVN
4 weeks ago
At HCSC, we empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. This position is responsible for performing discharge care coordination and review activities to determine the efficiency, effectiveness, and quality of medical/surgical services. The ideal candidate will serve as a liaison between providers and medical and network management divisions, reviewing service requests, collecting clinical and non-clinical data, verifying eligibility, and determining benefit levels in accordance with contract guidelines. The role also involves conducting initial and concurrent reviews, preparing reports on quality of care, identifying and reporting cases, and providing information regarding utilization management requirements and operational procedures to members, providers, and facilities. This position requires a valid, current, unrestricted license in the state of operations and 3 years of clinical experience in a physician office, hospital, or surgical setting. The candidate should possess excellent customer service skills, knowledge of medical terminology and procedures, verbal and written communication skills, and interpersonal skills. Willingness and ability to travel are also required.
Key Responsibilities:
- Perform discharge care coordination and review activities
- Review service requests and collect clinical and non-clinical data
- Verify eligibility and determine benefit levels
- Conduct initial and concurrent reviews
- Prepare reports on quality of care
- Identify and report cases
- Provide information regarding utilization management requirements and operational procedures
Requirements:
- Valid, current, unrestricted license in the state of operations
- 3 years of clinical experience in a physician office, hospital, or surgical setting
- Excellent customer service skills
- Knowledge of medical terminology and procedures
- Verbal and written communication skills
- Interpersonal skills
- Willingness and ability to travel
Preferred Requirements:
- Utilization review or utilization management experience
- MCG Certification
This position is a remote opportunity.
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.
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