Utilization Review Coordinator LPN
Company: Heartland Health
Location: Saint Joseph
Posted on: June 6, 2021
- Utilization Review Coordinator LPN
- Department: Utilization Management
- Full Time Status
- Variable Shift
- 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.
- 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
- 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
- Perform general data-entry into system software
- Other duties as assigned
- 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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