LPN/LVN Utilization Management Coordinator, Anywhere

Other Jobs To Apply

015987AboutSagilitySagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.Job title:LPN/LVN Utilization Management CoordinatorJob Description:We are currently hiring a LPN/LVN Utilization Management Coordinator. This role is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of client’s benefits plan. The Utilization Management (UM) Coordinator is responsible for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Utilization Management Coordinator has a key role in ensuring the client meets CMS compliance standards in the area of service decisions and organizational determinations. Successful candidates must have a current, valid Massachusetts clinical license in good standing.Key responsibilities:• Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but not limited to Durable Medical Equipment/Services, Long Term Services and Supports (LTSS), and Home Health (HH)• Applies established criteria (e.g., InterQual and other available guidelines) and employs clinical expertise to interpret clinical criteria to determine medical necessity of services• Communicates results of reviews verbally, in the medical record, and through official written notification to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements• Provides decision-making guidance to clinical teams on service planning as needed• Works closely with Clinicians, Medical Staff and Peer Reviewers to facilitate escalated reviews in accordance with Standard Operating Procedures• Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy• Works with UM Manager and other clinical leadership to ensure that departmental and organizational policies and procedures as well as regulatory and contractual requirements are met• Creates and maintains database of denied service requests• Additional duties as requested by supervisor• Standard office conditions. Some travel to clinical practices may be required.Education:• Associate degree• MA clinical license in good standing.Experience:• Required: 3+ years combined clinical and utilization management experience• Strong plus: 3+ years’ experience working in a health plan and/or experience with a care management platformSkills:• Ability to apply predetermined criteria (e.g., InterQual) to service decision requests to assess medical necessity• Flexibility and understanding of individualized care plans• Ability to influence decision making• Strong interpersonal, verbal and written communication skills• Ability to work independently• Comfort working in a team-based environment• Will be required to pass credentialing process.Hourly Rate: $28 - $36 pending experience and other factors.Hours: Monday through Friday 9AM to 5PM Eastern Time. Occasional weekends may be required.This is a fully remote work at home role. You must have a secure, private wok at home area with a hardwired internet connection with speeds greater than 5MB upload and 10MB download.Sagility Offers Competitive Benefits Including:• Medical• Dental• Vision• Life Insurance• Short-Term and Long-Term Disability• Flexible Spending Account• Life Assistance Program• 401K with employer contribution• PTO and Sick Time• Tuition ReimbursementJoin our team, we look forward to talking with you!An Equal Opportunity Employer/Vet/DisabilityLocation:Work@Home USAUnited States of America

Back to blog
Ads

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...