Clinical Reviewer LPN LVN Specialist
HCA Healthcare, Las Vegas, NV, United States
Hourly Wage Estimate
Hourly Wage Estimate: $23.62 - $35.44 / hour
Learn more about the benefits offered ( https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards ) for this job.
The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.
This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).
Job Summary and Qualifications
The Clinical Reviewer LPN-LVN Specialist is responsible for performing retrospective medical reviews based on patient eligibility and contract requirements.
Responsibilities
Perform a retrospective review of medical records using clinical expertise and Medicaid guidelines to determine medical necessity for emergent inpatient admissions and outpatient services.
Perform clinical reviews and maintain clinical documentation in accordance with HCA policy, procedures, and job aids
Submit authorization request based on state deadlines using various State portals
Review deferred accounts and update according to payer request
Review denied account to determine justification for Appeal requests
Maintains clinical documentation according to HCA’S documentation policy
Perform TAR reviews and completion of TAR requests according to Medi Cal format and deadlines
Performs Medi Cal Clinical medical file review of hospital documentation for necessary clinical treatment and patient severity of illness to warrant admissions and continued acute inpatient level of care
Knowledge of care management plans and services in order to implement that knowledge in a clinical setting
Meet productivity requirement as established by leadership
Assists in the orientation and training of new clinical staff
Demonstrate proficiency in Microsoft Office applications and others as required
Experience
A minimum of one-year Revenue Cycle experience with denials, appeals, managed care, verifications, and precertification preferred
1-2 years experience in acute care environment
3 years experience with utilization management in managed care and/or hospital setting preferred
Experience working in a remote setting
Work from home roles require employees must have high speed internet 60 MB download and 10 MB upload.
Qualifications
Maintains an active LPN/LVN license in good standing
LVN/LPN from accredited nursing school
Benefits
Comprehensive benefits
for medical, prescription drug, dental, vision, behavioral health and telemedicine services
Wellbeing support,
including free counseling and referral services
Time away from work
programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
Savings and retirement resources
, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
Education support
through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
Additional benefits
for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts
Note: Eligibility for benefits may vary by location.
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
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Hourly Wage Estimate: $23.62 - $35.44 / hour
Learn more about the benefits offered ( https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards ) for this job.
The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.
This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).
Job Summary and Qualifications
The Clinical Reviewer LPN-LVN Specialist is responsible for performing retrospective medical reviews based on patient eligibility and contract requirements.
Responsibilities
Perform a retrospective review of medical records using clinical expertise and Medicaid guidelines to determine medical necessity for emergent inpatient admissions and outpatient services.
Perform clinical reviews and maintain clinical documentation in accordance with HCA policy, procedures, and job aids
Submit authorization request based on state deadlines using various State portals
Review deferred accounts and update according to payer request
Review denied account to determine justification for Appeal requests
Maintains clinical documentation according to HCA’S documentation policy
Perform TAR reviews and completion of TAR requests according to Medi Cal format and deadlines
Performs Medi Cal Clinical medical file review of hospital documentation for necessary clinical treatment and patient severity of illness to warrant admissions and continued acute inpatient level of care
Knowledge of care management plans and services in order to implement that knowledge in a clinical setting
Meet productivity requirement as established by leadership
Assists in the orientation and training of new clinical staff
Demonstrate proficiency in Microsoft Office applications and others as required
Experience
A minimum of one-year Revenue Cycle experience with denials, appeals, managed care, verifications, and precertification preferred
1-2 years experience in acute care environment
3 years experience with utilization management in managed care and/or hospital setting preferred
Experience working in a remote setting
Work from home roles require employees must have high speed internet 60 MB download and 10 MB upload.
Qualifications
Maintains an active LPN/LVN license in good standing
LVN/LPN from accredited nursing school
Benefits
Comprehensive benefits
for medical, prescription drug, dental, vision, behavioral health and telemedicine services
Wellbeing support,
including free counseling and referral services
Time away from work
programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
Savings and retirement resources
, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
Education support
through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
Additional benefits
for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts
Note: Eligibility for benefits may vary by location.
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
#J-18808-Ljbffr