Retrospective Review LPN

Daily Responsibilities:

• Reviews medical records against specific guidelines and recommends a case disposition.
• Applies clinical knowledge in the assessment, evaluation and interpretation of clinical notes submitted by the provider.
• Evaluates the medical record so that patient age, time of day, severity of injury, availability of medical resources, etc. are considered when adjudicating the PLP case.
• Documents the clinical aspects of the case and the reasoning for the determination outcome in numerous databases.
• Verifies eligibility, timeliness and record completeness of ER PLP cases and follows up with the provider as necessary.
• Electronically enters claim detail information in organization applications including Sidewinder and documents receipt, disposition and other noteworthy aspects of the cases in the application.

Hours for this Position:

M-F 8am – 5pm

Advantages of this Opportunity:

• Competitive salary, negotiable based on relevant experience
• Benefits offered, Medical, Dental, and Vision
• Fun and positive work environment

What We Look For:

• Active LPN license in NJ
• 1-2 years of utilization management experience
• Managed care experience preferred

Are you an experienced Retrospective Review LPN in Newark, NJ area looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a company that provides on-going training and development? Are you interested in working for a company that offers benefits for full-time permanent employees, flex schedules and the opportunity to grow with the company? If you answered “yes” to any of these questions – this is the position for you!

If you are interested in being considered for this position, please click the apply button below.