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LPN Utilization Management Coordinator
Job Summary
A company is looking for a Utilization Management Coordinator (Home-Based) - Prior Authorization.
Key Responsibilities
- Monitor resource utilization, risk management, and quality of care for patients
- Obtain and maintain documentation for services in line with reimbursement agency guidelines
- Input collected data into systems for insurance communication and ensure medical necessity during patient hospitalization
Required Qualifications
- Seven years of relevant experience with a minimum of one year in healthcare or clinical settings
- Currently holds an unencumbered Licensed Practical Nurse (LPN) license or Registered Health Information Technician (RHIT) certification
- Experience in healthcare reimbursement, insurance industry, and/or authorization preferred
- Possesses relevant coding certifications such as CCS, CCS-P, CPC, CPC-H, COC, or CAC
- Appropriate education level as required by licensure
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COMPLETE JOB DESCRIPTION
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