Dection Staffing Services
Currently seeking an LVN Case Manager for a company in Anaheim, CA! If qualified, please submit your resume and apply below. You may also contact Liz directly @ (949)421-6006.(Call or Text)
This position, under the direction of the Manager of Prior Authorizations, is responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities and ancillary providers.
- Responsible for tasks/functions related to prior authorization and referral process.
- Actively participate in telephone on-line responsibilities as well as selected off-line tasks/functions.
- Responsible for applying medical criteria and policies/procedures to authorization or referral requests from medical professionals, clinical facilities and ancillary providers.
- Directly interact with provider callers, acting as a resource for their needs.
- Receives reviews, verifies and processes requests for referrals, diagnostic testing, inpatient admissions, outpatient procedures/testing, emergency room notification, home health care services, and durable medical equipment and supplies via telephone or fax.
- Completes all documentation accurately and appropriately for data entry in the utilization management system at the time of the telephone call of fax to include any authorization updates.
- Reviews all requests for medical appropriateness by using established clinical protocols to determine the medical necessity of the request.
- Screens requests for the Medical Director review, assuring the gathering of pertinent medical information prior to submission to the Medical Director and follows up per standard time frame to the requester with the decision by the Medical Director and documents this follow-up in the utilization management system.
- Accurately codes each diagnosis of service and procedures according the established policy and procedure.
- Contacts the Health Networks Customer Service regarding health network enrollments.
- Identifies and reports any complaints to immediate supervisor utilizing the Call Tracking system, or through verbal communication if the issue is of urgent nature.
- Meets identified productivity and quality of work standards on an ongoing basis.
Possess the Ability To:
- Maintain an understanding of current CPT-4, ICD-10 and HCPCS codes and continual updates to knowledge base regarding the codes.
- Communicate effectively both verbally, especially over the phone, and in writing.
- Travel to locations with frequency as the employer determines is necessary or desirable to meet its business needs.
Experience & Education:
- Current LVN license to practice in the State of California.
- Active CCM certification preferred.
- Minimum of three (3) years current clinical experience preferred.
- Managed care experience preferred.
- Excellent telephone skills required.
- Computer experience desirable.
- Excellent interpersonal skills.
- ICD 10- CM and CPT/ HCPCS Medical Coding.
- Strong problem solving, organizational skills and time management skills with the ability to work in a fast-paced environment.