License Practical Nurse

License Practical Nurse

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

Duties:

Complete face to face visits with members in case management and as directed by the case manager. This role requires driving to multiple locations in a given day and will cover multiple counties. Case Manager will provide the series of questions that need to be asked. The goal is to educate members on their benefits and advise them on how they are utilize them to their fullest potential. Hands off care, more observing and documenting through computer. Candidate must be a self-starter.

Qualifications:

• Active, unrestricted State Nursing License Practical Nurse, license in good standing for the State of Ohio.
• 5+years of LPN with home care experience.
• Driving around the Columbus, OH area.
• Completion of an accredited Registered Nursing program. (a combination of experience and education will be considered in lieu of Registered Nursing degree).
• Minimum 0-2 years of clinical practice. Preferably hospital nursing, utilization
• Active, unrestricted State Nursing (LPN) license in good standing.

Additional Information:

All your information will be kept confidential according to EEO guidelines.