Retrospective Review LPN

Why You Should Work For Us:

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Daily Responsibilities:

• Reviews medical records against specific guidelines and recommends a case disposition.
• Applies clinical knowledge in the assessment, evaluation and interpretation of clinical notes submitted by the provider.
• Evaluates the medical record so that patient age, time of day, severity of injury, availability of medical resources, etc. are considered when adjudicating the PLP case.
• Documents the clinical aspects of the case and the reasoning for the determination outcome in numerous databases.
• Verifies eligibility, timeliness and record completeness of ER PLP cases and follows up with the provider as necessary.
• Electronically enters claim detail information in organization applications including Sidewinder and documents receipt, disposition and other noteworthy aspects of the cases in the application.

Hours for this Position:

M-F 8am – 5pm

Advantages of this Opportunity:

• Competitive salary, negotiable based on relevant experience
  
• Benefits offered, Medical, Dental, and Vision
• Fun and positive work environment

What We Look For:

• Active LPN license in NJ
• 1-2 years of utilization management experience
• Managed care experience preferred
  

Are you an experienced Retrospective Review LPN in Newark, NJ area looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a company that provides on-going training and development? Are you interested in working for a company that offers benefits for full-time permanent employees, flex schedules and the opportunity to grow with the company? If you answered “yes” to any of these questions – this is the position for you!

If you are interested in being considered for this position, please click the apply button below.