Licensed Vocational Nurse

What you'll be doing: Responsible for working with healthcare provider to help ensure appropriate and consistent administration of plan benefit through collecting clinical information required to assess medical necessity, out of network services, and appropriateness of treatment setting. Applying appropriate medical policy, clinical guideline, plan benefit and scripted algorithm within scope of licensure. Review of claim edit, pre noted inpatient admission or episodic outpatient therapy such as physical therapy that is not associated with a continuum of care, radiology review or other such review process. Develop relationship with physician, healthcare service provider, and internal and external customer to help improve health outcome for member.

What your background should be: Two years of clinical or utilization review experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted license or certification in applicable state required. Knowledge of the medical management process preferred.

Who is the client company: This company is working to transform health care with trusted and caring solutions.; If you are interested in this position, send your resume to apply@kochdavis.com