Medical Reviewer LVN

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Job Summary

This Position Is Responsible For Performing Discharge Care Coordination And Review Activities For Determining Efficiency, Effectiveness And Quality Of Medical/Surgical Services And Serving As Liaison Between Providers And Medical And Network Management Divisions. Review Service Requests, Collect Clinical And Non-Clinical Data, Verify Eligibility, Determine Benefit Levels In Accordance To Contract Guidelines, Conducting Initial And Concurrent Review, Prepare Reports On Quality Of Care, Identify And Report Cases, And Provide Information Regarding Utilization Management Requirements And Operational Procedures To Members, Providers And Facilities. Willingness And Ability To Travel.

JOB REQUIREMENTS:
*LVN with valid, current, unrestricted license in the state of operations.
*3 years of clinical experience in physician office, hospital/surgical setting.
*Customer service oriented to assist internal/external customers.
*Knowledge of medical terminology and procedures.
*Verbal and written communication skills.
*Interpersonal skills and team player.
*Willingness and ability to travel.
*Familiar with PC or database systems.
*Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.

PREFERRED JOB REQUIREMENTS:
*Utilization review or utilization management experience.
*MCG Certification.

This role is 100% remote, must reside within IL

Hours: Monday-Friday 8:30-5pm CT w/ alternating weekend requirements

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HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$43,900.00 - $97,700.00