MedStar Health
LPN Case Manager Clinical Authorization
MedStar Health, Washington, District of Columbia, us, 20022
LPN Case Manager Clinical Authorization
– MedStar Health
Provide support for the Care Management Department by coordinating and promoting comprehensive, cost‑effective, quality care.
Requires 1-2 years of utilization review experience and 3-4 years of diverse clinical experience.
Key Responsibilities
Assist in identification of potential Case Management candidates through clinical review and appropriate referrals.
Contribute to department goals, adhere to policies, and comply with governmental and accreditation regulations.
Demonstrate behavior consistent with MedStar Health mission, vision, goals, and patient care philosophy.
Identify and report coordination of benefits, subrogation, third‑party liability, workers’ compensation cases, and quality, risk, or utilization issues.
Initiate contact with providers to obtain clinical information and facilitate care, including pre‑certification requests.
Interact with assigned disease management populations to improve patient access to care and provide education.
Maintain current knowledge of MedStar Family Choice benefits and enrollment issues.
Serve as a resource for benefit interpretation and coordination.
Maintain accurate documentation in the IS System per Case Management policy.
Participate in meetings, work groups, and other assigned activities.
Process pre‑authorizations for medical necessity, LOC, covered benefits, and provider participation per guidelines.
Submit reviews to Medical Reviewer as appropriate and coordinate review decisions and notifications.
What We Offer
Collaborative, inclusive, diverse, supportive work environment.
Career mentoring and growth opportunities.
Competitive salary and total rewards benefits.
Regional and national recognition, advanced technology, and leading medical innovations.
Qualifications
1‑2 years of utilization review experience.
3‑4 years of diverse clinical experience.
Active DC LPN license.
Hiring Range:
$60,632 – $107,494
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– MedStar Health
Provide support for the Care Management Department by coordinating and promoting comprehensive, cost‑effective, quality care.
Requires 1-2 years of utilization review experience and 3-4 years of diverse clinical experience.
Key Responsibilities
Assist in identification of potential Case Management candidates through clinical review and appropriate referrals.
Contribute to department goals, adhere to policies, and comply with governmental and accreditation regulations.
Demonstrate behavior consistent with MedStar Health mission, vision, goals, and patient care philosophy.
Identify and report coordination of benefits, subrogation, third‑party liability, workers’ compensation cases, and quality, risk, or utilization issues.
Initiate contact with providers to obtain clinical information and facilitate care, including pre‑certification requests.
Interact with assigned disease management populations to improve patient access to care and provide education.
Maintain current knowledge of MedStar Family Choice benefits and enrollment issues.
Serve as a resource for benefit interpretation and coordination.
Maintain accurate documentation in the IS System per Case Management policy.
Participate in meetings, work groups, and other assigned activities.
Process pre‑authorizations for medical necessity, LOC, covered benefits, and provider participation per guidelines.
Submit reviews to Medical Reviewer as appropriate and coordinate review decisions and notifications.
What We Offer
Collaborative, inclusive, diverse, supportive work environment.
Career mentoring and growth opportunities.
Competitive salary and total rewards benefits.
Regional and national recognition, advanced technology, and leading medical innovations.
Qualifications
1‑2 years of utilization review experience.
3‑4 years of diverse clinical experience.
Active DC LPN license.
Hiring Range:
$60,632 – $107,494
#J-18808-Ljbffr