Utilization Management Clinician LPN job

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Job Description

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: The Utilization Review (UM) Clinician (LPN) performs clinical reviews to assess medical necessity of a broad range of outpatient and inpatient services, while maintaining compliance with all regulatory requirements.

Interfaces with medical directors, and both internal and external stakeholders, with regard to coverage for services, contract benefits and alternate resources available.

This position interfaces frequently with treating providers in the gathering of clinical information and may also provide education on the medical review process.

The Utilization Management clinician (LPN) makes coverage decisions based on specific criteria including Milliman.

Frequently collaborates with Fidelis medical directors in determining coverage of requested services.

Interacts with members to assist with accessing appropriate resources for requested services.

Education/Experience: Associate’s degree preferred; Bachelors Degree preferred. 1-3 years Utilization Review experience preferred. Managed care experience preferred

License/Certification: NYS LPN License Required

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

TITLE: Utilization Management Clinician LPN

LOCATION: Latham, New York

REQNUMBER: 1353297

green circle info icon  This position is open. This job was posted on Fri Sep 30 2022 and expires on Sun Oct 30 2022.
Minimum $30K/yr
$45K/yr Average
Maximum $67K/yr

Tasks

  • Administer prescribed medications or start intravenous fluids, noting times and amounts on patients' charts.
  • Observe patients, charting and reporting changes in patients' conditions, such as adverse reactions to medication or treatment, and taking any necessary action.
  • Answer patients' calls and determine how to assist them.
  • Measure and record patients' vital signs, such as height, weight, temperature, blood pressure, pulse, or respiration.
  • Provide basic patient care or treatments, such as taking temperatures or blood pressures, dressing wounds, treating bedsores, giving enemas or douches, rubbing with alcohol, massaging, or performing catheterizations.
  • Work as part of a healthcare team to assess patient needs, plan and modify care, and implement interventions.
  • Supervise nurses' aides or assistants.
  • Evaluate nursing intervention outcomes, conferring with other healthcare team members as necessary.
  • Assemble and use equipment, such as catheters, tracheotomy tubes, or oxygen suppliers.
  • Record food and fluid intake and output.
  • Collect samples, such as blood, urine, or sputum from patients, and perform routine laboratory tests on samples.
  • Prepare patients for examinations, tests, or treatments and explain procedures.
  • Help patients with bathing, dressing, maintaining personal hygiene, moving in bed, or standing and walking.
  • Apply compresses, ice bags, or hot water bottles.
  • Sterilize equipment and supplies, using germicides, sterilizer, or autoclave.
  • Make appointments, keep records, or perform other clerical duties in doctors' offices or clinics.
  • Provide medical treatment or personal care to patients in private home settings, such as cooking, keeping rooms orderly, seeing that patients are comfortable and in good spirits, or instructing family members in simple nursing tasks.
  • Set up equipment and prepare medical treatment rooms.
  • Prepare or examine food trays for conformance to prescribed diet.
  • Wash and dress bodies of deceased persons.
  • Inventory and requisition supplies and instruments.
  • Clean rooms and make beds.
  • Assist in delivery, care, or feeding of infants.

Skills

  • Reading Comprehension - Understanding written sentences and paragraphs in work related documents.
  • Active Listening - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
  • Writing - Communicating effectively in writing as appropriate for the needs of the audience.
  • Speaking - Talking to others to convey information effectively.
  • Critical Thinking - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
  • Active Learning - Understanding the implications of new information for both current and future problem-solving and decision-making.
  • Learning Strategies - Selecting and using training/instructional methods and procedures appropriate for the situation when learning or teaching new things.
  • Monitoring - Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
  • Social Perceptiveness - Being aware of others' reactions and understanding why they react as they do.
  • Coordination - Adjusting actions in relation to others' actions.
  • Instructing - Teaching others how to do something.
  • Service Orientation - Actively looking for ways to help people.
  • Complex Problem Solving - Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
  • Judgment and Decision Making - Considering the relative costs and benefits of potential actions to choose the most appropriate one.
  • Time Management - Managing one's own time and the time of others.

Knowledge

  • Administration and Management - Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.
  • Clerical - Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
  • Customer and Personal Service - Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
  • Mathematics - Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
  • Chemistry - Knowledge of the chemical composition, structure, and properties of substances and of the chemical processes and transformations that they undergo. This includes uses of chemicals and their interactions, danger signs, production techniques, and disposal methods.
  • Psychology - Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.
  • Sociology and Anthropology - Knowledge of group behavior and dynamics, societal trends and influences, human migrations, ethnicity, cultures and their history and origins.
  • Medicine and Dentistry - Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.
  • Therapy and Counseling - Knowledge of principles, methods, and procedures for diagnosis, treatment, and rehabilitation of physical and mental dysfunctions, and for career counseling and guidance.
  • Education and Training - Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.
  • English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
  • Public Safety and Security - Knowledge of relevant equipment, policies, procedures, and strategies to promote effective local, state, or national security operations for the protection of people, data, property, and institutions.
  • Law and Government - Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
  • Tuition Assistance
  • 401K Plan
  • Vacation & Paid Time Off
  • Health Insurance
  • Remote
  • Employee Stock Purchase Plan

Centene Corporation

Description

Centene Corporation is a Fortune 500 enterprise serving as an intermediary for both government-sponsored and privately insured health care programs. The main lines of Centene include Medicaid, where it is the largest provider in the country; ACA health insurance marketplace plans (under the Ambetter brand); Medicare; Tricare and traditional commercial insurance. The corporation's foundational belief is that everyone deserves access to high-quality, affordable healthcare with dignity. Working for Centene, you are offered a competitive benefits package, continuous development plans and opportunities (through Centene University) as well as retirement plans. The company puts an emphasis on sustainability from energy-efficient buildings to enterprise-wide recycling efforts as well as meals based on locally sourced ingredients for employees. Through the Centene Charitable Foundation, the company invests in organizations and institutions that improve the lives of local communities, with a focus on holistic wellness.
Type

Company - Public

Size

Large

Revenue

Over $10B

Location

Latham, NY, 12110and others

Industry

Finance & Insurance Companies, Insurance Agency & Brokerage Firms

Founded

1984

Website

Visit Website

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