Top 6 Lpn utilization review Jobs in New York Ny

Clinician, Denials Prevention - Remote
Med-Metrix —Garden City, NY
- $80,000 - $85,000 a year
- Full-time
- Remote
- RN License
- Customer service
- Writing skills
Utilization Management (UM) Clinical Team Lead
MetroPlus Health Plan —New York, NY
- $124,836 a year
- Full-time
- Hybrid work
- RN License
- Physical & Rehabilitation Medicine
- Mid-level
Utilization Management Manager
Healthfirst —New York, NY
- $99,700 - $168,810 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
9h
Coordinator
Wyckoff Heights Medical Center-WHN —New York, NY
- $56,824.59 a year
- RN License
- No high school diploma
- Mid-level
Case Manager ( RN / RT / SW / LPN )
Select Specialty Hospital - NE NJ Rochelle Park —Rochelle Park, NJ
- Full-time
- RN License
- Inpatient
- Mid-level
- Dental insurance
- Paid time off
Quick Apply
MDS Director
Long Term Health Care —Linden, NJ
- Full-time
- Nursing
- Skilled nursing facility
- RN License
Quick Apply
10d

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Utilization Management (UM) Clinical Team Lead
MetroPlus Health Plan —New York, NY
Valid New York State license and current registration to practice as a Registered Professional Nurse (RN), License Practical Nurse (LPN), or Physical Therapist…
$124,836 a year
Director, Utilization Management
Healthfirst —New York, NY
Bachelor’s degree in healthcare, business, or a related field from an accredited institution or equivalent work experience.
$127,500 - $236,555 a year
9h

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Intake LPN Home Health and Hospice
SHC WVUHS Home Care —Columbus, OH
Current Licensed Practical Nurse license issued by the state in which services will be provided or current multi-state Licensed Practical Nurse license through…
13d
LPN - 1st Shift
The Buckeye Ranch —Grove City, OH
You have an LPN license in the state of Ohio. You have an active driver’s license and proof of auto insurance. Shift Differentials: Added to base rate.
$23.82 - $30.00 an hour
Quick Apply

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lpn utilization review jobs near new york ny

Clinician, Denials Prevention - Remote

Med-Metrix -
Garden City, NY

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Job Details

Full-time
$80,000 - $85,000 a year

Qualifications

Customer communication
Writing skills
MFA

Full Job Description

Job Purpose
The Clinician, Denials Prevention, uses their clinical and administrative skills to analyze denials and appeal outcomes; share opportunities with clients to reduce first pass denials by ensuring proper patient status, authorizations, clinical documentation opportunities, staff education, and collaboration with other departments.

Duties & Responsibilities

Maintain the integrity of information in each appeal produced
Review a high volume of written appeals to ensure information is medically accurate
Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment
Make recommendations for workflow revisions to improve efficiency and reduce denials
Present case studies and recommendations to clients and impacted stakeholders
Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate
Identify opportunities for process improvement and actively participate in process improvement initiatives, internally and externally
Other duties as assigned
Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Understand and comply with Information Security and HIPAA policies and procedures at all times
Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

Bachelor’s degree in a health-related field; 2 years of experience may be considered in lieu of a degree in addition to the required experience. LPN or RN preferred.
Two years of recent experience in hospital case management, hospital prior authorization, or utilization management
Experienced in medical chart review
Claim-related appeal writing experience preferred
Experience with medical and insurance terminology, CPT, ICD coding structures, and billing forms
Experience with MCG and/or InterQual guidelines preferred
Proficiency in Microsoft Office Suite
Strong interpersonal skills, ability to communicate well at all levels of the organization
Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
High level of integrity and dependability with a strong sense of urgency and results oriented
Excellent written and verbal communication skills required
Gracious and welcoming personality for customer service interaction

Working Conditions

Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

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lpn utilization review jobs in new york ny

Clinician, Denials Prevention - Remote

Utilization Management (UM) Clinical Team Lead

Utilization Management Manager

Coordinator

Case Manager ( RN / RT / SW / LPN )

MDS Director

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