Licensed Practical NurseUS Tech Solutions, Inc. • Columbia, SC, United States
Licensed Practical Nurse
US Tech Solutions, Inc. • Columbia, SC, United States
30+ days ago
Job type
- Full-time
Job descriptionUtilizes clinical proficiency and claims knowledge / analysis to assess, plan, implement, health coach, coordinate, monitor, and evaluate medical necessity and / or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review / authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. May initiate / coordinate discharge planning or alternative treatment plans as necessary and appropriate. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.). Participates in data collection / input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). Participates in direct intervention / patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and / or health and disease management programs. Provides telephonic support for members with chronic conditions, high risk pregnancy or other at risk conditions that consist of : intensive assessment / evaluation of condition, at risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and / or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. 2 years clinical experience. Working knowledge of word processing software. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Ability to remain in a stationary position and operate a computer. Required Software and Tools : Microsoft Office. Preferred Skills and Abilities : Working knowledge of spreadsheet and database software. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Preferred Software and Others Tools : Knowledge of Microsoft Excel, Access, or other spreadsheet / database software. Graduate of an Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing. Active, unrestricted LPN / LVN licensure from the United States and in the state of hired, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC),
Job Description :
- Monday Through Friday, 8 : 30am-5pm Virtual Interviews - MS Teams 1-2 Weeks Of Onsite Training Then Associate Will Have The Option To Work Remote.
- Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions.
Responsibilities :
Experience :
Skills :
Education :
About US Tech Solutions :
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity,
national origin, disability, or status as a protected veteran.
Create a job alert for this search
Licensed Practical Nurse • Columbia, SC, United States
Related jobs
MUSC Community Physicians (MCP) is an entity within the Medical University of South Carolina that provides healthcare to patients within the rural health network throughout the state of South Carol...Show more
Department of Soldier Care, Moncrief Army Health Clinic, Fort Jackson.Certificate / Graduate from an accredited community college, junior college, college, University, or vocational nursing program a...Show more
Make a Difference on Your Own Schedule and Terms!.Performs nursing functions in accordance with the federal, state, and local laws and within the state-specific scope of practice of a licensed prac...Show more
Sign-On Bonus Available! About Midlands Regional Center Midlands Regional Center is a residential facility of the South Carolina Department of Disabilities and Special Needs located in Columbia, ...Show more
Pro Active MD is looking for a Licensed Practical Nurse to join our team.This person is responsible for assisting physicians while providing treatment to patients with a variety of medical conditio...Show more
BC / BE Family Medicine Physicians Needed Near Gaston, SC.A well established practice is seeking BC / BE Family Medicine physicians to join their beautiful, new practice.
This is a great opportunity to ...Show more
LICENSED PRACTICAL NURSE Join the PruittHealth family, where the health and safety of our workforce is our top priority! We're not only committed to your career, we're committed to the health and...Show more
Become a part of our caring community and help us put health first.Make a meaningful impact every day as a CenterWell Home Health nurse.
You’ll provide personalized, one-on-one care that helps patie...Show more
BC / BE Family Medicine Physicians Needed Near Gaston, SC.A well established practice is seeking BC / BE Family Medicine physicians to join their beautiful, new practice.
This is a great opportunity to ...Show more
Join Our Team as a Licensed Practical Nurse (LPN).Do you value the time you spend with your patients? Is it important to you that your patients and their families know and feel that you are with th...Show more
Find your new career with a team of HEROES, who are extraordinary people doing ordinary things for seniors.We are dedicated to giving back and supporting our team members, local community, and othe...Show more
Join a Team Where Care Meets Independence.Registered Nurse – Home Health | Ridgeway, SC.We're currently seeking a compassionate and dependable.
Full-Time Licensed Practical Nurse (LPN).Ridgeway, Bly...Show more
Family Medicine NP- Winnsboro, TX- CHRISTUS Health.Physician-Led Organization : Clinicians have a seat at the table through our Physician Board of Directors.
AI-Enabled Documentation Support : We use ...Show more
Family Practice - Without OB Physician at Pacific Companies summary : .This locum tenens opportunity for a Family Practice Physician in the Carolinas offers a flexible schedule and community-focused ...Show more
Monday Through Friday, 8 : 30am-5pm Virtual Interviews - MS Teams 1-2 Weeks Of Onsite Training Then Associate Will Have The Option To Work Remote.
Reviews and evaluates medical or behavioral eligibili...Show more)
Job Description Summary MUSC Community Physicians (MCP) is an entity within the Medical University of South Carolina that provides healthcare to patients within the rural health network throughout...Show more LICENSED PRACTICAL NURSE - 7p-7a Join the PruittHealth family, where the health and safety of our workforce is our top priority! We're not only committed to your career, we're committed to the he...Show more 
Job Responsibilities • You will, under general supervision, assist the medical monitoring and treatment of all consumers during their stay at the Center, and provide a variety of complex paraprofe...Show more
Licensed Practical Nurse
MUSC Health & Medical University of SC • Columbia, SC, United States
Full-time
Last updated: 30+ days ago • Promoted
LPN - Licensed Practical Nurse
Professional Performance Development Group, Inc • Columbia, South Carolina, United States
Full-time
Quick Apply
Last updated: 30+ days ago
Licensed Practical Nurse - LPN - Home Health
Professional Case Management • Gaston, SC, USA
Full-time +1
Last updated: 30+ days ago • Promoted
Licensed Practical Nurse Institutional
State of South Carolina • Killian, SC, United States
Full-time
Last updated: 30+ days ago • Promoted
Licensed Practical Nurse (PRN)
Proactive MD • Columbia, SC, US
Full-time
Quick Apply
Last updated: 30+ days ago
Physician / Family Practice / South Carolina / Permanent / BC / BE Family Medicine Physicians Needed N
MD Staff, LLC • Gaston, SC, US
Permanent
Last updated: 30+ days ago • Promoted
Licensed Practical Nurse
PruittHealth • Ridgeway, SC, United States
Full-time
Last updated: 30+ days ago • Promoted
Licensed Practical Nurse, Home Health
CenterWell Home Health • Columbia, SC, United States
Full-time
Last updated: 30+ days ago • Promoted
Physician / Family Practice / South Carolina / Locum or Permanent / BC / BE Family Medicine Physicians
Hayman Daugherty Associates, Inc • Gaston, SC, US
Permanent
Last updated: 30+ days ago • Promoted
Licensed Practical Nurse (LPN) 7p-7a
Agape Care Group • Swansea, SC, United States
Full-time
Last updated: 1 day ago • Promoted
Licensed Practical Nurse I / RN FT / PT
Maxwell Group • Columbia, SC, United States
Full-time +1
Last updated: 30+ days ago • Promoted
Licensed Practical Nurse Home Health
Medical Services of America • Ridgeway, SC, United States
Full-time
Last updated: 30+ days ago • Promoted
NP - Family Medicine
CHRISTUS Health • Winnsboro, US
Full-time
Last updated: 1 day ago • Promoted
Family Practice - Without OB Physician
Pacific Companies • North, SC, USA
Permanent
Last updated: 30+ days ago • Promoted
Licensed Practical Nurse
US Tech Solutions, Inc. • Columbia, SC, United States
Full-time
Last updated: 30+ days ago • Promoted
Licensed Practical Nurse | Family Medicine (MCP)
MUSC (Med. Univ of South Carolina) • Columbia, SC, United States
Full-time
Last updated: 30+ days ago • Promoted
License Practical Nurse (7p-7a)
PruittHealth • Columbia, SC, United States
Full-time
Last updated: 30+ days ago • Promoted
Licensed Practical Nurse (LPN) 2nd Shift - Evaluation Center
State of South Carolina • South Congaree, SC, United States
Full-time
Last updated: 30+ days ago • Promoted