Coordinates with healthcare providers and plan members to maximize member benefits while managing costs.
Assesses medical necessity of patient admissions, surgical and diagnostic procedures, and other related services. Conducts pre-certification or authorization, and monitors compliance with established medical guidelines and policies. May assist members in appeals for denied services.
Salary.com identifies five increasing levels of proficiency for each skill/competency. Some jobs require only a relatively low level of proficiency in each skill/competency, while other jobs will require a more advanced level of proficiency in the same skill/competency. These levels rate the degree of proficiency (skill level, expertise) we expect the incumbent to perform in the given skill/competency for the given job. Note that we intentionally do not associate timeframes or years of experience in performing the skill/competency because that can be misleading. Proficiency levels identify what the incumbent knows and can do rather than how long they have been doing it. Also, note that the proficiency levels are cumulative, e.g., a level 4 proficiency implies the ability to perform all the behaviors at the lower levels.
Check each Licensed Practical Nurse - Medical Management skill and competencie below to view definitions.
Skill definition-Utilizing effectively a set of tools, methods, and practices in analyzing the performance and efforts to successfully improve the overall process.
Level 1 Behaviors
(General Familiarity)
Names the industry best practices in conducting a quality improvement program.
Level 2 Behaviors
(Light Experience)
Supports the implementation and improvement of the Quality Management System.
Level 3 Behaviors
(Moderate Experience)
Uses various quality methodologies such as Kaizen and Six Sigma to conduct improvement projects.
Level 4 Behaviors
(Extensive Experience)
Provides feedback on quality issues to ensure continuous quality improvement.
Level 5 Behaviors
(Mastery)
Leads cross-functional improvement projects to improve quality, cost, and service excellence.
Skill definition-Connecting patients with suitable healthcare providers, resources, and services to ensure they receive optimal, cost-effective care.
Level 1 Behaviors
(General Familiarity)
Names several intervention techniques and clinical services used in case management.
Level 2 Behaviors
(Light Experience)
Updates clients' records to reflect their latest treatment procedures, condition, and progress.
Level 3 Behaviors
(Moderate Experience)
Translates gathered data into a care plan that details the client's health objectives and healthcare options.
Level 4 Behaviors
(Extensive Experience)
Recommends changes in the treatment plan or alternative steps when the expected treatment results are not obtained.
Level 5 Behaviors
(Mastery)
Sets the process and metrics in evaluating the efficacy or impacts of the case management program on clients.
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Lists the traits of an employee showing great attention to detail.
Level 2 Behaviors
(Light Experience)
Utilizes specific approaches and tools for checking and cross-checking outputs.
Level 3 Behaviors
(Moderate Experience)
Uses tools to organize and monitor work progress.
Level 4 Behaviors
(Extensive Experience)
Manages training to improve staffs' concentration and attention to detail.
Level 5 Behaviors
(Mastery)
Learns from previous works' strengths and weaknesses to guide new projects.
Skill definition-Managing and setting priorities, goals, and timetables to boost productivity and efficiency in completing tasks.
Level 1 Behaviors
(General Familiarity)
Lists basic planning tools and applications used in tracking and organizing time and tasks visually.
Level 2 Behaviors
(Light Experience)
Seeks all resources needed to accomplish a task efficiently and effectively.
Level 3 Behaviors
(Moderate Experience)
Works closely with colleagues to identify and reduce interruptions and barriers to time utilization.
Level 4 Behaviors
(Extensive Experience)
Provides strategic direction to the workforce in managing time to avoid low-value work.
Level 5 Behaviors
(Mastery)
Monitors the performance of business units to determine and eliminate deviations from priorities.
There are 0 hard skills for Licensed Practical Nurse - Medical Management.
9 general skills for Licensed Practical Nurse - Medical Management, Quality Improvement, Case Management, Managed Care Management, etc.
6 soft skills for Licensed Practical Nurse - Medical Management, Attention to Detail, Time Management, Flexibility, etc.
While the list totals 15 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Licensed Practical Nurse - Medical Management, he or she needs to be proficient in Attention to Detail, be proficient in Time Management, and be proficient in Flexibility.
