Licensed Practical Nurse - Medical Management 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. Being a Licensed Practical Nurse - Medical Management conducts pre-certification 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 requires a high school diploma. Typically reports to a registered nurse or supervisor. Requires graduation from approved LPN educational program. Requires a state license to practice. Licensed Practical Nurse - Medical Management's years of experience requirement may be unspecified. Certification and/or licensing in the position's specialty is the main requirement. (Copyright 2024 Salary.com)
Responsibilities:
Under the supervision of the registered nurse, advanced practice registered nurse, or other health care provider authorized by the state; the Licensed Practical Nurse (LPN) will participate in the development, implementation and modification of the comprehensive plan of care for facility residents and will practice within the legal boundaries for practical nursing authorized by the state for the delivery of patient care and related services.
Qualifications: