LPN Nurse Reviewer Description
Affiliated Computer Services, Inc. (ACS) is expertise in action™. We are a FORTUNE 500 company with 74,000 employees worldwide supporting client operations reaching more than 100 countries. We provide business process outsourcing and information technology solutions to world-class commercial and government clients. Our employees operate with integrity, and are flexible, reliable and responsive. If you meet the requirements of this position and want to work for a world-class company with a great marketplace reputation, apply today.
Functional Description:
Performs certification of services/procedures (concurrent and retrospectively). Acts as patient/family advocate in coordinating and accessing medical necessity health care services within the benefit plan.
- Uses established medical criteria to certify services based on information obtained from attending physician and/or other providers. Refers cases that do not meet criteria to Medical Director.
- Identifies potential cost savings within a plan coverage. Acts upon cost savings in instances when services would not be sacrificed by doing so.
- Participates in quality improvement strategies by assessing individual and employer satisfaction with programs.
- Adheres to URAC Standards for accredited Utilization Review program
Performs all activities within the scope of licensure, certification, and Federal & State laws.
Education and Typical Years Experience
- Licensed Practical Nurse with active and unrestricted license to practice in the State of Missouri.
- Minimum 3 years nursing experience in an acute care or relevant setting requiring nursing decision making
- Utilization review experience preferred
- Experience using Milliman Care Guidelines preferred
- Effective communication skills—verbal, written, interpersonal, and phone, in order to work cooperatively, tactfully, and assertively with medical providers and others.
- Proficiency in basic computer skills, such as Microsoft Windows (including Word, Excel and Outlook), and ability to access and navigate the Internet (to conduct research).
All other duties as assigned.
ACS is an Equal Opportunity Employer and does not Discriminate against any applicant on the basis of race, color, religion/creed, national origin, gender, or sex, marital status, age, disability, use of a guide dog or service animal, sexual orientation, military/veteran status, or any other status protected by Federal or State law or local ordinance. People with disabilities who need a reasonable accommodation to apply or compete for employment with ACS may request such accommodations by calling 866-419-2226 .
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