Utilization Management Specialist (LPN)

Location: Bronx, NY
Responsibilities Include:
  • Establish and maintain positive relationships with patients, visitors, and other employees.
  • Contributes to and participates in the performance/quality improvement activities of the assigned department.
  • Contribution and participation includes data collection, analysis, implementation of compliance with risk management and claims activities
  • Support of and participation in Continous Quality Improvement (CQI) teams, constant adherence to the specific rules and regulations of the Bronx-Lebanon Hospital Center (a) Safety and Security Policies (b) Risk Management: Incident and Occurrence Reporting (c) Infection Control Policies and Procedures and (d) Patient and Customer Service, (e) Employee adherence to the Organization's Policy, Procedures and Regulations.
  • Performs audits on timeliness of clinical reviews on a weekly basis
  • Conducts audits on the timeliness of Discharge IMM and 24 hr. notice of discharge
  • Responsible for sending discharge deliveries and nursery admission appropriate payers in a timely manner.
  • Assist with the preparation of the UM Committee meeting including taking/typing minutes.
  • Responds to notices related to patient discharge appeals for IPRO and Medicare by collecting and sending clinical information
  • Responding to IPRO/Livanta discharge appeals
  • Works with the director/associate director to prepare quarterly PI reports and other reports as directed
  • Conducts audits on UM staff to determine the number of reviews and maintenance of UM work list in conjunction with the Director and/or Associate Director.

Required Experience:
  • NY State LPN with at least 2 years of clinical experience
  • Experience with spreadsheets/pivot tables
  • Clinical Auditing experience
  • Experience in responding to IPRO/Livanta discharge appeals
  • Excellent interpersonal, written and verbal communications
April A. Estes
Senior Recruiter
720-439-2609 Direct

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