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)
Follows methods, standards, and cost analysis systems to promote quality improvement.
Level 2 Behaviors
(Light Experience)
Suggests needed changes in the existing process to correct and/or eliminate quality issues.
Level 3 Behaviors
(Moderate Experience)
Partners with the senior management in developing continuous improvement plans to drive excellence.
Level 4 Behaviors
(Extensive Experience)
Oversees the identification of process improvement opportunities to achieve quality targets.
Level 5 Behaviors
(Mastery)
Establishes an effective quality management system to identify opportunities for improvement.
Skill definition-Connecting patients with suitable healthcare providers, resources, and services to ensure they receive optimal, cost-effective care.
Level 1 Behaviors
(General Familiarity)
Explains the differences between the brokerage, strengths-based, and clinical case management models.
Level 2 Behaviors
(Light Experience)
Schedules patients’ medical appointments and conducts follow-ups to ensure they attended their consultations.
Level 3 Behaviors
(Moderate Experience)
Provides a customized care plan to clients based on their medical history and current financial and living situation.
Level 4 Behaviors
(Extensive Experience)
Partners with healthcare and human services providers to increase client satisfaction and promote cost-effectiveness.
Level 5 Behaviors
(Mastery)
Redefines ineffectual case management programs to deliver high-quality healthcare services and attain client objectives.
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Lists best practices and tools to maintain high accuracy and thoroughness in the workplace.
Level 2 Behaviors
(Light Experience)
Uses checklists to ensure that information goes out error-free.
Level 3 Behaviors
(Moderate Experience)
Suggests solutions to issues that arise while executing the tasks.
Level 4 Behaviors
(Extensive Experience)
Employs techniques for motivating personnel to meet or exceed accuracy goals.
Level 5 Behaviors
(Mastery)
Leads the creation of tools for enhancing and assuring accuracy.
Skill definition-Managing and setting priorities, goals, and timetables to boost productivity and efficiency in completing tasks.
Level 1 Behaviors
(General Familiarity)
Explains the importance of time management in driving the overall productivity of our business.
Level 2 Behaviors
(Light Experience)
Follows an updated calendar to list and complete tasks and assignments according to priority level.
Level 3 Behaviors
(Moderate Experience)
Utilizes departmental tools and best practices to organize tasks effectively and productively.
Level 4 Behaviors
(Extensive Experience)
Manages teams in streamlining work-related tasks to prioritize highest value tasks firsts.
Level 5 Behaviors
(Mastery)
Leads transformational changes to work plans to drive the proper utilization of time and resources.
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.
