Website Extended Managed Long Term Care

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Extended Managed Long Term Care

Join our team as one of the fastest-growing Certified Home Health Care Agencies and Managed Long Term Care programs in greater New York City, with offices in Manhattan, Brooklyn and Staten Island.

LPN Utilization Nurse
Full Time
Staten Island Location

Excellent opportunity for a LPN Utilization Nurse to be responsible for reviewing authorization requests/claims for medical necessity, under the direction and supervision of the UNM.

Responsibilities:
• Act as a liaison between the care manager and the provider
• Reports to Utilization Nurse Manager
• Utilizes the Utilization Nurse Manager as a resource for all clinical questions and advice
• Serve as part of the team for treatment plans. Follows up with all necessary parties regarding treatment requests
• Reviews the appropriateness and medical necessity of the treatment requests for utilization review on a prospective, concurrent, and retrospective basis. Report their findings to UNM for determination
• Reviews and assists with coordination of the POC
• Reviews the quality and clinical risk issues on a concurrent basis; report any recognized issue to the UNM
• Reviews the documentation in the medical records for completeness and relationship to the treatment plan and reports findings to UNM
• Able to obtain and interpret information appropriate to the members needs as required for assessment, treatment, and patient care services, as delegated by the UNM
• Provide assistance and guidance to all parties with regard to the authorization request/claim process
• Assist with analysis of outcome data to identify and make recommendations; report issues to the UNM
• Develop and maintain a positive work atmosphere and support the overall team; demonstrate ability to work within a team structure
• Practice capable and effective problem identification and resolution skills as a method of sound decision making
• Maintain confidentiality
• Work independently, efficiently, and deals with priorities, under the direction and supervision of the UNM
• Ability to function as a Utilization Nurse and any other duties as assigned
• Practice nursing within the Scope of Practice as designated
• Employee may be asked to travel from time to time to attend employer meetings or other offsite functions.
• Demonstrates sound judgment by taking appropriate actions regarding suspected violation of corporate compliance regulations.
• Reports all suspected violations to supervisor, Compliance Officer or Compliance Hotline.

Qualifications:
• Licensed Practical Nurse
• A minimum of five (5) years of full-time employment in home health care, utilization, and nursing.
• Excellent verbal/written communication skills, strong organizational skills, and good judgment

We offer competitive salaries and excellent benefits including training, support and professional growth.

Please visit our website at www.extendedhc.net and click on the “Apply Now” tab to send us your resume, email: [email protected] or fax to 212-564-7812

Extended Home Care Agency is an Equal Opportunity Employer.

To apply for this job email your details to ehchr@extendedhc.net

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