Licensed Practical Nurse (LPN) - Utilization Review
Bethesda, MD 20814 US
Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, Maryland to provide care to Active Duty heroes, their families, and retirees at Walter Reed National Military Medical Center. Scheduled hours are from 0700AM - 3: 30PM Mon - Fri with 30 minute unpaid lunch period. Schedule will not exceed 80 hours within a 2-week pay period. Services will be required on Federal holidays.
DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW:
- Initiate, perform and complete assigned duties in providing care to variable patient populations.
- Complete assigned patient care based on the patients conditions, use judgment in selecting the appropriate order and sequence of procedures and treatments, and accurately recognize, report and record relevant patient information.
- Observe, identify and respond to the patient s needs for care, including medication, equipment-assisted care and patient/family education.
- Prepare and administer prescribed medications (oral, topical, subcutaneous, intramuscular and/or intravenous) and perform treatments according to established policies/procedures.
- Recognize urgent or emergent patient care situations, seek assistance of the RN and/or MD/DO, and initiate appropriate emergency interventions as directed.
- Perform support duties for complex diagnostic tests and/or specialized practices or procedures, which include preparing the patient, assisting in the diagnostic examination, preparing and handling specialized instruments or other specialized equipment, and monitoring the patient s condition before, during, and following the procedure.
- Orient peers and ancillary personnel to unit policies and procedures, skills, and standards of practice.
- Integrate healthy work environment principles that result in improved patient healthcare delivery, education of patients and their families and employee satisfaction.
- Perform clinical reviews to assess medical necessity of broad range of inpatient and outpatient services while maintaining compliance with all governmental and regulatory requirements.
- Assess the necessity and validity of the item(s) supplied in a valid claim through the use of medical policy and other materials.
- Interact with Uniform Business Office (UBO) staff, business managers, support staff, department heads and Comptroller.
- Generate appropriate written correspondence to providers, support staff, other stakeholders and regulatory entities.
- Interact with both internal and external stakeholders with regard to coverage for services, contract benefits and alternate resources available.
- Interface frequently with treating providers in gathering clinical information and may also provide education on the medical review process.
- The Contractor performing as the License Practical Nurse (LPN) Utilization Reviewer (UR) shall make coverage decisions based on DoD regulations, and reference use of Milliman Care criteria and InterQual guidelines.
- The Contractor shall frequently collaborate with managers of the UBO, Utilization Review Registered Nurse (RN) and pre-certification clerk.
- The Contractor shall interact with members of the Third Party Collections (TPC) team (i.E. Financial billers).
- The Contractor shall provide utilization reviews for both inpatient and outpatients in a timely fashion.
- The Contractor shall perform pre-cert and authorization of insurance pertaining to patient admission and surgical admission as well as prior authorizations (PA) for high dollar mediations.
QUALIFICATIONS OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW:
- Degree: Graduate from an accredited community college, junior college, college, university or vocational nursing program approved by the appropriate State agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: Diploma of LPN or LVN, from and accredited by the National League for Nursing Commission for Nursing Education Accreditation (CNEA) or the Commission on Collegiate Nursing Education (CCNE). LPN certification is required.
- Experience: Requires a minimum of 2 years of clinical and utilization review experience or any combination of education and experiences which would provide an equivalent background.
- Ability to lift and move 25 pounds. May be required to stand, bend and reach from open medical record shelving.
- Licensure: Current, full, active, and unrestricted license to practice as a practical or vocational nurse.
- US Citizen (for access to government computer systems)
COMPENSATION & BENEFITS FOR THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW:
- Competitive pay
- 10 days paid time off per year plus 7 sick days per year
- 11 paid Federal holidays
- Health & Welfare allowance mostly cover the cost of health insurance, long and short-term disability, and life insurance
- Dental and vision plans offered, 401(k)
ABOUT THE ARORA GROUP:
The Arora Group is an award-winning, Joint Commission-certified nationwide healthcare services company that, for almost 30 years, has provided medical care for the men and women who serve our country in the U.S. Armed Forces. Our mission is to provide world-class care and give our healthcare professionals opportunities to improve their skills, learn from the best, and serve the needs of active duty service members, their families, and veterans.
EOE AA M/F/Vet/Disability