About the role
HealthCare Strategies is seeking an experienced Licensed Practical Nurse (LPN) to join our remote Utilization Management team.
If you're looking for a flexible, part-time opportunity to work from home while applying your clinical expertise in a fast-paced, collaborative environment, we'd love to hear from you.
This fully remote position is scheduled for 20–25 hours per week, Monday through Friday, during daytime business hours. There are no weekends or holidays.
Why Join HealthCare Strategies?
Fully remote position
Part-time schedule (20–25 hours/week)
Monday through Friday – no weekends or holidays
Flexible schedule Monday-Friday; 10a-5:30p range
Supportive and collaborative clinical team
Opportunity to make a meaningful impact on patient care
Established company with more than 40 years of experience in healthcare management
Position Summary
The Licensed Practical Nurse (LPN) facilitates requests for medical services for a variety of health benefit plans by performing telephonic clinical reviews, applying evidence-based clinical criteria, documenting reviews, and communicating with providers and members. The LPN identifies opportunities for case management referrals while ensuring timely, accurate, and professional customer service.
Essential Responsibilities
Receive and review requests for medical services and obtain the clinical information necessary to complete an initial medical necessity review.
Apply approved evidence-based clinical criteria to support initial review determinations.
Refer cases that do not meet established clinical criteria to supervisory staff or physician reviewers for further review.
Identify members who may benefit from our Case Management or HealthReach services and generate timely referrals.
Accurately document all clinical reviews, communications, and member information in the electronic medical management system.
Prepare and transmit authorizations and other communications within required timeframes.
Answer incoming telephone calls, triage requests, retrieve voicemail and email messages, and provide exceptional customer service to providers and members.
Explain benefit plan requirements and HealthCare Strategies' role in the review process.
Interpret Summary Plan Descriptions, including plan benefits, exclusions, and limitations.
Maintain confidentiality of protected health information and comply with HIPAA and company policies.
Qualifications
Required
Active, unrestricted Compact Licensed Practical Nurse (LPN) license.
Minimum of one (1) year of recent direct patient care experience in a hospital or acute care setting.
Strong clinical assessment and critical thinking skills.
Excellent verbal and written communication skills.
Strong organizational and time management abilities.
Ability to work independently in a remote environment.
Basic computer skills, including Microsoft Outlook and data entry.
Preferred
Previous Utilization Management, Prior Authorization, Case Management, or Managed Care experience.
Experience working with electronic health records (EHR) or healthcare information systems.
Technical Requirements
Dedicated home office or quiet workspace.
Reliable high-speed internet with minimum speeds of 25 Mbps download and 25 Mbps upload.
If you're a compassionate, detail-oriented nurse who enjoys combining clinical knowledge with excellent customer service, we encourage you to apply and become part of our growing team.
Originally posted on Himalayas