LPN Case Manager Clinical Authorization

General Summary of Position Provides support for the Care Management Department by coordinating and promoting comprehensive quality cost-effective care. *1-2 years Utilization review experience required* *This role requires you to be on-site in Washington, DC, four days per week, with one remote workday each week.* Key Responsibilities Assists in the identification of potential Case Management candidates through clinical review, selected diagnoses, etc., and makes appropriate referrals. Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations. Demonstrates behavior consistent with MedStar Health mission, vision, goals, objectives and patient care philosophy. Identifies and reports potential coordination of benefits, subrogation, third party liability, workers compensation cases, etc. Identifies quality, risk, or utilization issues to appropriate MedStar personnel. Initiates contact with providers to obtain clinical information to facilitate care or pending pre-certification requests. Interacts with assigned disease management populations of limited volume. Interaction is designed to improve patient access to care, and education regarding the disease and support services. Maintains current knowledge of MedStar Family Choice benefits and enrollment issues in order to accurately coordinate services. Maintains expertise in general benefit management and serves as a resource for MedStar Family Choice members, physicians, and staff for benefit interpretation and coordination. Maintains timely and accurate documentation in the IS System per Case Management policy. Participates in meetings, work groups, etc. as assigned. Processes pre-authorizations for medical necessity, LOC, covered benefits, and participation of the provider at the discretion of the guidelines and Medical Reviewer. Sends reviews to Medical Reviewer as appropriate. Coordinates review decisions and notifications, per policy. What We Offer Culture- Collaborative, inclusive, diverse, and supportive work environment. Career growth- Career mentoring to help you pursue your passions and gain skills to enhance your value. Wellbeing- Competitive salary and Total Rewards benefits to help keep you happy and healthy. Reputation- Regional & National recognition, advanced technology, and leading medical innovations. Qualifications 1-2 years Utilization review experience required. 3-4 years Diverse clinical experience required. Active DC LPN License required. This position has a hiring range of $60,632 - $107,494 #J-18808-Ljbffr