Job Title: LPN

Must Haves:

• Completion of an accredited LPN program

• Possess a current Florida LPN license

• Ability to work at any DCMG location.

• Demonstrated computer skills.

Job Summary

• Perform medical record reviews to support improvement and compliance, abstract HEDIS data, to include over-read of reviews, working collaboratively with internal HEDIS STARs Team and the Quality Team.

• Perform administrative functions to include; medical record request, faxing and calls to members and providers as needed. Maintain organized, updated reporting of activities with clear documentation. Required to track, monitor and report on the status of records and volume of work.

• Complete claim research to identify the service performed, dates of service, provider type, and place of service. Research may include multiple systems and reports.

• Must have previous medical record / quality review experience; HEDIS/STARS preferred

• Must be proficient in Microsoft Office (Word, Excel, Outlook, and PowerPoint) as well as Internet research skills

• Ability to communicate clearly verbally and in writing

Job Requirements

• Knowledge of medical terminology

• Experience with prior authorization

• Experience applying nationally recognized criteria, including InterQual

• Ability to navigate through multiple systems and screens to resolve authorization or medical review requests

• Talking and typing simultaneously

• Effective time management skills

• Effective interpersonal and communication skills

• Ability to use electronic medical record and claims systems

• Problem solving abilities

• Work cooperatively, positively, and collaboratively in an interdisciplinary team

Preferred:

• Disease management experience is helpful

• Recent experience in medical record reviews, data collection for HEDIS Stars

Required Experience:

• 2 years related work experience

Required Education:

• High School Diploma or GED

Required Licenses and Certifications

• LPN Licensed Practical Nurse State Licensure