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)
Describes the industry best practices in developing and implementing care plans for clients.
Level 2 Behaviors
(Light Experience)
Records medical history, current financial and living status, and social support situation of clients.
Level 3 Behaviors
(Moderate Experience)
Manages arrangements for patient post-discharge treatment at home or post-acute care facilities.
Level 4 Behaviors
(Extensive Experience)
Monitors and evaluates the efficiency of interventions, plan of care, and clinical services provided to clients.
Level 5 Behaviors
(Mastery)
Establishes a case management program that details an organized approach to offering client case management services.
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Identifies the procedures for making sure that results are mistake-free.
Level 2 Behaviors
(Light Experience)
Records all appointments on the calendar to easily track daily activities.
Level 3 Behaviors
(Moderate Experience)
Reviews and analyzes the accuracy of data and details.
Level 4 Behaviors
(Extensive Experience)
Designs systems to help the team organize and track details and project progress.
Level 5 Behaviors
(Mastery)
Develops best practices for identifying and correcting errors, oversights, and omissions.
Skill definition-Managing and setting priorities, goals, and timetables to boost productivity and efficiency in completing tasks.
Level 1 Behaviors
(General Familiarity)
Discusses workplace barriers and issues that may affect time management.
Level 2 Behaviors
(Light Experience)
Collects and compiles information in an organized manner to finish tasks efficiently.
Level 3 Behaviors
(Moderate Experience)
Handles workplace obstacles to maintain focus and manage time efficiently.
Level 4 Behaviors
(Extensive Experience)
Improves processes to organize workloads of teams efficiently.
Level 5 Behaviors
(Mastery)
Keeps current on the latest working models on time management to drive organizational productivity.
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.
