Remote Utilization Management Clinician (LPN, BSN)
Company: Elohim Group LLC
Location: Lees Summit
Posted on: January 9, 2021
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Job Description:
SCOPE OF ROLEThe Utilization Management Clinician uses clinical
knowledge, communication skills, and independent critical thinking
skills towards interpreting criteria, policies, and procedures to
provide the best and most appropriate treatment, care or services
for members. Coordinates and communicates with providers, members,
or other parties to facilitate optimal care and treatment. This
role makes decisions regarding own work methods, occasionally in
ambiguous situations, and requires minimal direction and receives
guidance where needed while following established
guidelines/procedures.ROLE RESPONSIBILITIESRESPONSIBILITIES % OF
TIME1. Provides first level clinical review for all medical and
surgical authorization requests against applicable criteria,
policies and procedures. Accurately documents all reviews and
contacts providers and members according to established timeframes.
80%2. Acts as a member advocate by expediting the care process
through the continuum, working in concert with the health care
delivery team to maintain high quality and cost-effective care
delivery. 10%3. Screening and coordination of cases within the
utilization management department and other Bright clinical teams
including Case Management, Care Navigation and Transitions of Care
to ensure optimal care for members 5%4. Escalates all potential
quality issues and grievances to correct Bright workflows
5%Experience/Requirements:
Keywords: Elohim Group LLC, Lee's Summit , Remote Utilization Management Clinician (LPN, BSN), Executive , Lees Summit, Missouri
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