2nd Annual Fund Raiser

Career Center

JOB TITLE: Utilization Review Nurse — LPN

REPORTS TO: Quality Improvement/Rehab Coordinator

JOB SUMMARY: A licensed practical nurse, under the direction and guidance of a registered Nurse, who promotes optimum delivery of care to clients by compiling and analyzing documentation for Medicare reimbursable services and through Utilization Review and Quality Improvement activities.

QUALIFICATIONS:

  • Must meet all of the criteria in the LPN qualifications in the LPN job description.
  • Minimum of two years experience as an Intake Nurse in home health agency.
  • Thorough knowledge of Medicare guidelines and the skill to generate reimbursable documentation.
  • Excellent verbal and written communication skills.

ESSENTIAL JOB RESPONSIBILITIES:

  • Demonstrates current knowledge of federal and state rules and regulations.
  • Reviews Medicare, Medicaid, and commercial insurance orders and documentation for certification/recertification prior to submission to physician and billing.
  • Reports to supervisor as appropriate any unusual circumstances or staff learning needs regarding reimbursable documentation.
  • Assists billing and data entry personnel as needed with proper ICD-9CM coding of diagnosis and procedures.
  • Assists with quarterly Utilization Review Chart audits.
  • Assists with reporting of Utilization Review findings to management and staff and offers recommendations as needed.
  • Assists with documentation review.
  • Participates with Quality Improvement activities as assigned.
  • Participates in professional organizations.
  • Attends continuing education programs.

NON-ESSENTIAL JOB RESPONSIBILITIES:

  • Performs other duties as assigned by Utilization Review Coordinator.