LPN Authorization Nurse Coordinator
The LPN Authorization Coordinator will determine if requests for care meet coverage requirements and if care is medically appropriate/necessary. Provide members and referring providers’ education/information on care available within our network. Assist in coordinating the services with the re-direction of care to in-network provider when needed. This will be done to promote the highest quality of care in the most appropriate setting in the most cost-effective manner.
Primary Duties and Responsibilities
• Accurately gather and interpret information obtained to determine coverage and medical appropriateness/ necessity. Identify if care requested is available in network and at the appropriate setting.
• Assess and identify appropriate resource utilization, level of care, and treatment options. This is accomplished within regulatory timeframes.
• Collaborate with the member and/or the multi-disciplinary healthcare team to develop an evidenced-based plan of care that enhances quality, access, and cost effective outcomes.
• Follow up on any questions/concerns from the member or provider.
• Promote the timely provision of healthcare services and the effective utilization of resources.
• Effectively cultivate and maintain working relationships with all providers of care and employers by regular/timely communication and professional rapport when indicated.
• Demonstrates self-directed, self-motivated, responsible behavior.
• Respects confidentiality of all persons involved.
• Follows all state, federal and organization policy and procedure.
• Demonstrates knowledge of the health care plan, benefits and limitations.
• Demonstrates knowledge and works within regulatory timelines ( DOL and BBA)
• Demonstrates and utilizes knowledge of appropriate resources within the company, health care system and community.
Requirements:
• LPN with 5 years acute care experience.
• Previous physician office experience required.
• Experience with working knowledge of managed care issues.
• Intermediate computer/keyboard skills.
• Ability to manage multiple projects at one time
• Must be able to take various levels of responses for customers.
• Effective communications skills.
• Ability to speak English well enough to be understood by provider offices, co-workers and the public.
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