Licensed Medical Policy Specialist

Job Summary

A company is looking for a Medical Policy Specialist (RN/LPN) - Front End Referral Review.

Key Responsibilities

• Review incoming referrals against clinical coverage guidelines to ensure compliance and minimize financial loss
• Assist in identifying training needs and provide expertise for in-service training to improve team performance
• Resolve complex medical policy needs while maintaining timely patient care and building relationships with various teams

Required Qualifications

• Licensed Practical or Vocational Nurse (LPN/LVN) or Registered Nurse (RN), required
• Prior experience working with insurance, required
• Advanced knowledge of infusion procedures and terminology, required
• Thorough knowledge of potential medical safety concerns for formulary medications, required
• Minimal travel for transition and education purposes