Licensed Practical Nurse - Medical Management

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Licensed Practical Nurse - Medical Management is responsible for coordinating 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. Being a Licensed Practical Nurse - Medical Management conducts pre-certification and/or authorization, and monitors compliance with established medical guidelines and policies. May assist members in appeals for denied services. Additionally, Licensed Practical Nurse - Medical Management applies the medical and reimbursement policies within the claim adjudication process. May require a bachelor's degree. Requires Licensed Practical Nurse (LPN). Typically reports to a manager. The Licensed Practical Nurse - Medical Management work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Licensed Practical Nurse - Medical Management typically requires 0-2 years of related experience.