Medical Review Coordinator, LPN

🔥 2 hours ago

🇺🇸 United States – Remote

💵 $23 - $27 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 1%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

MedWatch, LLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1988

💼 Consulting

📦 Logistics

🛡️ Insurance

Consulting • Logistics • Insurance

MedWatch, LLC is a healthcare services company that provides utilization management, case management, disease management, member advocacy and concierge care coordination to payers, TPAs, and self‑insured employers. For over 35 years it has delivered clinically driven care management, precertification and claims solutions, direct contracting and ancillary services backed by URAC accreditations and proprietary in‑house technology to improve clinical outcomes and reduce plan and member costs.

📋 Description

• Perform duties according to MedWatch procedures, review standards, URAC standards, and state certification requirements • Review medical data received by mail or fax and enter it into the clinical record • Review and determine certification decisions for precertification cases forwarded by the utilization review specialist • Document all information according to MedWatch policy • Follow up post-procedure to obtain pathology reports and notify the claims office of results and additional treatment needed • Discuss cases lacking clinical information with the supervisor before referring them to the Physician Advisor • Follow up to ensure timely Physician Advisor responses within MedWatch guidelines • Obtain clinical information on pregnancy cases according to MedWatch protocol • Discuss high-risk OB cases with the Medical Review Specialist and provide information to the claims office • Forward cases to the assigned utilization review specialist for follow-up at delivery • Discuss potential case management referrals with the case management supervisor and refer cases as directed • Obtain discharge dates and bill totals at discharge to expedite case closure • Adhere to company policies and procedures • Assist with projects directed by the Director of Utilization Review • Participate in the Quality Management Program and identify opportunities for improvement • Perform other duties or responsibilities as assigned

🎯 Requirements

• Associate’s degree or equivalent education and experience • Current unrestricted Licensed Practical Nurse license in the state of practice • 3 years of clinical nursing experience • Good organizational skills and time management • Excellent verbal and written communication skills • Ability to handle difficult situations tactfully and diplomatically • Effective problem-solving and decision-making skills • Strong computer skills • Proficiency in MS Office Suite, including Word, Excel, and PowerPoint • Ability to work in the United States for any employer without sponsorship • Dedicated, quiet workspace in the home

🏖️ Benefits

• Paid time off • Medical insurance • Dental insurance • Vision insurance • Short-term disability • Long-term disability • Life insurance • AD&D insurance • 401(k) with match • Critical illness coverage • Legal plan • Identity theft coverage • Pet insurance • Discount programs • Competitive compensation • Dedicated, quiet home workspace for remote work

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume