LPN Clinical Reviewer

Company Information :

American Health Group, Inc (AHG) is a privately held health utilization management company located in Mesa, AZ. The organization was founded in 1984 and serves self-insured employer health groups in the Western US. The organization provides precertification, utilization review, case management, patient advocacy, disease intervention and wellness services.

Job Summary:

Applies clinical knowledge to make determinations for prior authorizations utilizing Medical Review Criteria/decision support tools to ensure adherence to health plan benefits. Compiles information needed to process prior authorization requests and documents in the medical management information system. Coordinates with third-party payers (TPA). Refers to case management/disease intervention program. Assists RN with patient calls for Case Management Program. Serves as a resource to non-clinical staff regarding clinical and coding questions. Scope and complexity Must have an exceptional understanding of the precertification process and medical procedures, services, and treatment. Must be well organized and can multi-task daily in a changing setting. Must have the ability to appropriately communicate with internal and external customers, diffuse angry customers, and function as a liaison between various departments. Must be able to use good judgment and make complex decisions. Works in accordance with all regulatory bodies and adheres to AHG policies and procedures. Must be able to function independently with minimal supervision. Job Qualifications

• LPN with current and unrestricted Arizona license
• 3 years medical/surgical clinical experience
• 2 additional years of experience and prefer in clinical review/utilization management
• Prior managed care/health insurance experience/coding preferred
• Excellent clinical judgment, written and verbal communication skills
• Highly organized and detail oriented
• Effective interpersonal, organizational and problem solving skills
• Team builder and player
• Solid computer skills and proficient in the use of Word, Excel and PowerPoint Salary/Benefits
• Competitive salary
• Vacation and personal days
• Group health insurance paid by the company (employee only)
• Paid Holidays
• Continuing education pertinent to position with supervisor approval

Pay:

From $29.00 per hour

Benefits:

Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person