Medical Review Coordinator / LPN

Scope: The Medical Review Coordinator will perform her/his duties in accordance with MedWatch procedures, MedWatch review standards, URAC standards and state certification requirements. Education: Associate’s degree or equivalent education and experience Licensure/Certification Requirements: Licensed Practical Nurse (current unrestricted, in state of practice) Experience: 3 years clinical nursing experience. Requirements/Skills: Good organizational skills and time management Excellent verbal and written communication skills Ability to handle difficult situations tactfully and diplomatically. Effective problem solving and decision-making skills. Strong computer skills with proficiency in MS Office Suite products (Word, Excel, PowerPoint) Duties and Responsibilities: Review medical data obtained by mail or fax and enter into the clinical record for review by the utilization review specialist. Review and determine certification decision for all precertification cases forwarded to her by the utilization review specialist. Document all information obtained according to MedWatch policy. Follow-up post procedure to obtain the pathology report as appropriate and send a notification memo to the claims office advising of the results and any additional treatment needed. Discuss all cases lacking clinical information to allow certification with her supervisor prior to sending to the appropriate Physician Advisor for review. Follow up to assure PA response timely within MedWatch guideline