HealthCare Strategies is seeking an experienced Licensed Practical Nurse (LPN) to join our remote Utilization Management team.
If you're looking for a flexible, part-time opportunity to work from home while applying your clinical expertise in a fast-paced, collaborative environment, we'd love to hear from you.
This fully remote position is scheduled for 20-25 hours per week, Monday through Friday, during daytime business hours. There are no weekends or holidays.
Why Join HealthCare Strategies?
• Fully remote position
• Part-time schedule (20-25 hours/week)
• Monday through Friday - no weekends or holidays
• Flexible schedule Monday-Friday; 10a-5:30p range
• Supportive and collaborative clinical team
• Opportunity to make a meaningful impact on patient care
• Established company with more than 40 years of experience in healthcare management
Position Summary
The Licensed Practical Nurse (LPN) facilitates requests for medical services for a variety of health benefit plans by performing telephonic clinical reviews, applying evidence-based clinical criteria, documenting reviews, and communicating with providers and members. The LPN identifies opportunities for case management referrals while ensuring timely, accurate, and professional customer service.
Essential Responsibilities
• Receive and review requests for medical services and obtain the clinical information necessary to complete an initial medical necessity review.
• Apply approved evidence-based clinical criteria to support initial review determinations.
• Refer cases that do not meet established clinical criteria to supervisory staff or physician reviewers for further review.
• Identify members who may benefit from our Case Management or HealthReach services and generate timely referrals.
• Accurately document all clinical reviews, communications, and member information in the electronic medical management system.
• Prepare and transmit authorizations and other communications within required timeframes.
• Answer incoming telephone calls, triage requests, retrieve voicemail and email messages, and provide exceptional customer service to providers and members.
• Explain benefit plan requirements and HealthCare Strategies' role in the review process.
• Interpret Summary Plan Descriptions, including plan benefits, exclusions, and limitations.
• Maintain confidentiality of protected health information and comply with HIPAA and company policies.
Qualifications
Required
• Active, unrestricted Compact Licensed Practical Nurse (LPN) license.
• Minimum of one (1) year of recent direct patient care experience in a hospital or acute care setting.
• Strong clinical assessment and critical thinking skills.
• Excellent verbal and written communication skills.
• Strong organizational and time management abilities.
• Ability to work independently in a remote environment.
• Basic computer skills, including Microsoft Outlook and data entry.
Preferred
• Previous Utilization Management, Prior Authorization, Case Management, or Managed Care experience.
• Experience working with electronic health records (EHR) or healthcare information systems.
Technical Requirements
• Dedicated home office or quiet workspace.
• Reliable high-speed internet with minimum speeds of 25 Mbps download and 25 Mbps upload.
If you're a compassionate, detail-oriented nurse who enjoys combining clinical knowledge with excellent customer service, we encourage you to apply and become part of our growing team.