grand rapids, Michigan
LPN Authorization Nurse Job Opening in grand rapids, Michigan - LPN Authorization Nurse The LPN Authorization Coordinator will determine if requests for care meet coverage requirements and if care is medically Provide members and referring providers? 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. ? 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. grand rapids mi michigan
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