Long Beach, California
LVN Authorization Coordinator Job Opening in Long Beach, California - CLIENT COMPANY OVERVIEW Our client is a Managed Care Health Plan that focuses on providing individuals with Medi-Cal, Medicare or Commercial coverage with convenient access to quality, evidence-based medicine, superior value, exceptional service and a network of integrated providers through multiple contracts with various health plans.
POSITION SUMMARY
LVN; Authorization Coordinator
(Managed Care Health Plan)
Under supervision of Chief Medical Officer and Registered Nurse provides utilization review and management for SHP members while at the same time promoting coordinating quality of care, in a timely and cost-effective manner.
Consistently provides decision making, complies with turn-around time frames, follows UM criteria to ensure processing of request for referral authorizations will not interfere with or cause delay in service, or preclude delivery of services.
This position is responsible for implementing and coordinating all utilization management functions relating to pre-certification of outpatient office visits, durable medical equipment, testing/surgery. The LVN authorization coordinator is responsible for coordinating authorizations, notifications, and pre-certifications.
Provides workflow, direction, organization and monitoring of management including CCS services. Coordinates and tracks authorization files between Authorization Coordinators and Physician reviewer.
Updates SHP systems to reflect current and ongoing authorization status of CCS cases.
QUALIFICATIONS & EDUCATION
Current California LVN License
Med-Surg acute care background/or 1-year clinical specialty required.
1-year managed healthcare; health plan required.
Prior experience with CCS preferred.
Medical terminology proficient
Knowledge of ICD9-10
Knowledge of CPT codes
COMPENSATION & SCHEDULE Monday - Friday (days) $28.00/hr
POSITION CLASSIFICATION Full Time / Contract To Hire
Job Type: Full-time
Salary: $26.00 to $28.00 /hour
Job Location:
Long Beach, CA
Required education:
High school or equivalent
Required experience:
Managed Care: 1 year
Med-Surg/ Clinical: 2 years
Authorizations: 1 year
Required license or certification:
LVN/LPN License
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