Utilization Management Lpn/lvn - Melbourne, United States - Christian Care Ministry

Christian Care Ministry

Verified Company

Melbourne, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Pay Range:
$ $33.17/hour

Interested applicants must be willing and able to work at least 3 days onsite in our Melbourne, FL office.

Who We Are
At Christian Care Ministry (CCM) we believe that Christians can, and should, share in one another's burdens. Through the use of Medi-Share, a healthcare sharing ministry for Christians, we cultivate that belief.

The Team
Everyone at Christian Care Ministry agrees to our Statement of Faith which outlines our core beliefs. Although we aren't perfect people, we are serving our perfect God to the best of our ability.

The Role

The _Utilization Management LPN/LVN_ ensures that Medi-Share members who need inpatient and/or outpatient medical services receive high quality, cost-efficient care to achieve optimum clinical outcomes.

Employing utilization management best practices, this role manages a diverse workload - performing prospective, concurrent, and retrospective utilization management/review-related functions while adhering to the organization's governing guidelines and standard medical rules.

This position will require the ability to work independently, in teams, and in multiple IT systems.

Essential Job Duties & Responsibilities

Works with leadership, clinical staff, key internal departments, and external customers to ensure optimum clinical outcomes for members
Reviews and interprets members' medical records and compares them against proprietary and evidencedbased criteria to determine eligibility for bill sharing and advocacy for additional programs and interventions; determines if the medical record documentation supports the eligibility of requested and/or billed services
Abstracts reviewrelated data/information accurately and timely in appropriate review systems by the appropriate means. Provides accurate and timely submission of all administrative and reviewrelated documents to appropriate parties
Performs ongoing reassessment of review process to offer opportunities for improvement and/or change
Reviews requests for genetic testing to determine eligibility for sharing and implements appropriate reimbursement strategies
Advocates for members using the Medi-Share program to meet their health care needs
Performs case reviews, checks medical records, speaks with patients and care providers regarding treatment and collaborates with plan of care
Reviews prenotification of services and clinical information for care management intervention and medical appropriateness
Performs clinical reviews paying close attention to the appropriateness of healthcare expenditures to include length of facility stays and outpatient therapy services
Performs concurrent review and discharge planning for inpatients
Provides for continuity of care
Researches and assists the negotiations for LOA/SCAs for inpatients transitioning to different level of care
Assures appropriate levels of care are received by patients
Provides appropriate consultation and referral to intra

- and interdepartmental resources to ensure members receive optimum services offered by organization

Manages assigned clinical caseload meeting SLAs
Performs administrative and clinical processes to ensure team and departmental goals are met
Delivers accurate and comprehensible verbal and written communication to external customers while complying with organizational HIPAA requirements
Maintains accurate and timely records of all communications and interventions
Attends all required department and organization meetings
Contributes to the exercise and expression of Christian Care Ministry's Christian beliefs
All other duties as assigned

Essential Skills & Abilities

Expert knowledge of Medi-Share program guidelines and processes
Strong organizational, prioritization, and process skills
Advanced Excel skills; intermediate Microsoft office skills (Outlook, Teams, Word)
Advanced knowledge of Salesforce, CSI/Eldorado use and documentation
Excellent computer skills ability to access, research and use multiple software programs simultaneously and keyboard skills of at least 35 words per minute
Excellent research skills to using IT systems, internet, and phone
Accurate data collection, documentation, and analysis provides effective and efficient collection and distribution of research data without the need for supervision; able to correlate research findings with solutions
Excellent ability to communicate effectively in written, oral, telephonic, and digital formats that build collaboration and facilitate positive outcomes
Ability to work independently and with a team regularly; able to perform assigned special projects with mínimal assistance
Ability to comply with HIPAA, PHI, and all call compliance rules and regulations
Excellent ability to provide all content within a Biblical framework

Core Competencies/Demonstrable Behaviors
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Collaborates - builds partnerships and works collaboratively with internal de