Utilization Analyst - LPN

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Utilization Analyst - LPN

Roanoke, VA, US, 24015

Employment Status: Full time

Shift: Day/Evening

Facility: Park View

Requisition Number: 147039

How You'll Help Transform Healthcare:

LPN (Remote Hybrid): This position is in the Performance & Quality Improvement Department, with a focus on supporting our Accountable Care Strategies (ACS) Team, assisting with chart review for upcoming appointments at our Family and Community Medicine/IM practices, entering external results, and completing medication adherence review; other duties as assigned. This position will not have direct patient contact.

As a member of the Care Management Team, performs utilization review functions that assist in the performance of case management, social services, and resource management.

• Keeps current with timelines, processing, and review criteria for multiple payers. Serves as a contact and resource for all members of the case management team and physicians on specific payers (payer specific specialist).

• Maintains knowledge of and compliance with changing State/Federal regulations impacting UR per departmental guidelines. Educates healthcare team members, patients and families on regulations as needed.

• Assists physicians in appropriate documentation to optimize patient's benefits and medical record coding.

• Performs admission and continued stay reviews in accordance with hospital policy and payer contract requirements to ensure appropriate reimbursement for services. Researches and responds to requests for additional information and/or follows through with notification of involved areas if inaccuracies are identified.

• Coordinates information/data sharing across departments as directed. Facilitates compilation and retrieval of case records and accounts as needed for audits, surveys, performance improvement, compliance and billing. Works with on site payer reviewers to ensure communication and collaboration of services.

• Assures data entry and reporting of statistical and operational/service indicators within specified time frames.

• Communicates with payers and refers issues to case manager, social worker, or physician, as necessary.

• Facilitates Physician Peer to Peer medical reviews as needed.

• Refers all potential/actual denials to Denial specialist for review and determination of appropriate appeal.

What We Require:

Education: LPN.

Experience: 3 years in a clinical setting providing direct patient care, or in Utilization Review.

Licensure, certification, and/or registration: LPN

Other minimum qualifications: Knowledge of insurance and Interqual guidelines helpful. Positive interpersonal oral communication skills; effective written communication skills; analytical skills; integrity; innovation; team player; courteous; ability to resolve complaints/problems; service excellence philosophy of service delivery; ability; willingness to work as an integral member of a multi skilled team.

About Carilion

This is Carilion Clinic ...

An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.

Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.

Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.

Requisition Number: 147039

Employment Status: Full time

Location: Park View

Shift: Day/Evening

Shift Details: M-F, 8-5, some flexibility

Recruiter: HAYLEY F OHL

Recruiter Email: hcfield@carilionclinic.org

For more information, contact the HR Service Center at 1-800-599-2537.

Equal Opportunity Employer

Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity

Carilion Clinic is a drug-free workplace.

Carilion Total Rewards

What matters to you is important to us-like benefits, rewards, and resources to improve your life. Carilion understands the importance of prioritizing your well-being to help you develop and thrive. When you make your tomorrow with us, we'll enhance your potential to realize the best in yourself. Below are benefits available to you when you join Carilion:

• Employer Funded Pension Plan, vested after five years (Voluntary 403B)

• Comprehensive Medical, Dental, & Vision Benefits

• Flexible Work Arrangements/Schedules

• Remote Work Options

• Paid Time Off (accrued from day one)

• Onsite fitness studios and discounts to our Carilion Wellness centers

• Access to our health and wellness app, Virgin Pulse

• Discounts on childcare

• Continued education and training

Find more about Carilion Clinic's benefits by vising our Total Rewards Page.

Equal Opportunity Employer

Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity

Carilion Clinic is a drug-free workplace.

Nearest Major Market: Roanoke

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