Utilization Management Coordinator / LPN Nurse
Job Opportunity at Chesterfield Companies

Posted on Jul 8

3308969777

Location: Uniontown, OH
Job Type: Full Time
Job ID: W4137338

UTILIZATION MANAGEMENT COORDINATOR / LPN Nurse

Chesterfield Companies is a third-party administrator for health claims located in Uniontown, Ohio.  We are looking to add to our staff.  Regular work hours will be from 8:00 am – 5:00 pm, Monday through Friday.

This position ensures coordination of quality health care services by identifying appropriate services and resources are being utilized in a timely and cost effective manner throughout the continuum of care. 

Summary of Job Responsibilities:

  • The Utilization Management Coordinator is an expert in the areas of utilization management, continuum of care planning, benefit interpretation, disease management, and insurance industry regulations.
  • Receive clinical information on an individual via fax or phone and apply it to existing criteria guidelines for determination of a recommended treatment plan.
  • Determine if received clinical information is adequate and appropriate for requested treatment plan.  Completes reviews within designated URAC timetable.
  • Perform care management activities as needed.  Is familiar with and will access all clinical criteria guidelines before determining need for secondary review.
  • Monitor changes in level of care (LOC) and appropriateness of changes.
  • Participate in discharge planning.
  • Reviews for medical necessity of durable medical equipment
  • Prioritize phones, pre-certifications and follow through for pre-certifications.
  • Completes appeal determinations received from Physician review.
  • Responsible for appropriate application of Medical Policy and criteria.
  • A representative of Healthcare Management Services across the corporation.

Required Qualifications:

  • Valid Ohio Licensed Practical Nursing License or Licensed Clinical Social Worker - REQUIRED
  • 2-3 years experience in Clinical Nursing

Additional relevant knowledge and/or skills and/or work experience:

  • Excellent written and verbal communication skills.
  • Ability to interact with all levels of the organization.
  • Ability to interact with external customers and providers.
  • Ability to analyze data, measure outcomes and develop action plans.
  • Highly effective interpersonal skills.
  • Recognized as a clinical nursing expert.
  • Ability to intervene in crisis situations and multi-task.
  • Excellent computer and software knowledge and skills.

What is in it for you:

 

Join an established company that appreciates its people

Competitive compensation

Excellent benefits package

Matching 401k

Medical insurance, Dental insurance, Vision insurance

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