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Utilization Review Coordinator LPN

Company: Heartland Health
Location: Saint Joseph
Posted on: June 6, 2021

Job Description:

Details

  • Utilization Review Coordinator LPN
  • Department: Utilization Management
  • Full Time Status
  • Variable Shift

Summary

  • This position is an LPN who reviews individual medical cases that are referred by Utilization Review Specialists to confirm the appropriate level of care. Responsible for conducting continued stay reviews for Medicare patients using Interqual guidelines and hospital policies. These nursing professionals work at the hospital. The goal of members of this profession is to balance the needs of a patient with the need to reinforce policies, keep costs reasonable, and ensure that patients are provided with medical treatment which is suited to their situations. Researches clinical documentation to assist in review, processing, and coordination of admission, concurrent, and retrospective medical necessity reviews. Serve as communication liaison between social workers, discharge planners, and physicians. This position requires adaptability and effective communication skills to build rapport with patients, families, peers, and physicians. Perform a variety of tasks with a certain degree of creativity and latitude required. This position is employed by Mosaic Health System.

Duties

  • Performs utilization reviews in accordance with the hospitals UM plan to ensure adherence to federal regulations
  • Educate patient and family of on the lack of medical necessity on for continued stays, HINN issuance.
  • Conducts inpatient concurrent and retrospective review for Medicare beneficiaries and self-pay patients based on CMS guidelines.
  • Uses national medical necessity tool to screen for appropriateness for inpatient level of care or observation services based on physician certification including history and physical, treatment plan, potential risks, and basis for expectation of a 2-midnight stay.
  • Perform general data-entry into system software applications.
  • Other duties as assigned

Qualifications

  • High school diploma and graduate of an accredited practical nursing program required.
  • Licensed Practical Nurse State Licensure in State of Missouri or Kansas, depending upon designated work location required. Basic Life Support certification required.
  • 3 years experience in a hospital or insurance industry required and knowledge of medical necessity tool guidelines preferred.

Keywords: Heartland Health, Saint Joseph , Utilization Review Coordinator LPN, Other , Saint Joseph, Missouri

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