Utilization Review Coordinator - Lpn
ACS inc (Milwaukee, Wisconsin)

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Job Description: We're here to help. In 1988, ACS founder and Chairman of the Board Darwin Deason recruited a group of extraordinary information technology professionals and instilled a passion and energy we call hustle. We believe the impossible is possible, and that giving up is not an option. We're Affiliated Computer Services, Inc. (NYSE: ACS), a premier provider of diversified business process outsourcing (BPO) and information technology outsourcing (ITO) solutions to commercial and government clients worldwide. Based in Dallas, ACS is a FORTUNE 500 company of 62,000 people supporting client operations reaching more than 100 countries. It would be hard for you to go through a day without encountering the products or services of our many clients in communications, education, energy, financial services, government, healthcare, insurance, manufacturing, retail, travel, and transportation. May perform one or more of the following duties: 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. ESSENTIAL DUTIES & RESPONSIBILITIES: ü Adheres to all Company policies, procedures, and rules. ü Adheres to all safety-related policies, procedures, and rules.Promotes a safety awareness and commitment at all times. ü Interacts professionally and efficiently with other Bowers & Associates employees to achieve the Company’s Vision and Mission Statement. ü Establishes and maintains effective working relationships with patients and their families, providers and payers. ü Maintains confidentiality of information of received, provided, or processed.Signs and adheres to the Bowers & Associates Confidentiality Agreement. ü Uses established medical criteria to certify services, based on information obtained from attending physician and/or other providers.Refers cases to Medical Director if they do not meet established medical criteria. ü Refer patients to appropriate resources to allow for positive outcomes relating to their disease state. ü Manages cases to discharge and/or referral. ü Regularly interacts with Third Party Administrators to exchange certification information. ü Identifies potential cost savings within a health plan’s coverage.Acts upon cost savings in instances when services would not be sacrificed by doing so. ü Adheres to URAC standards for programs which Bowers & Associates is currently accredited. ü Participates in quality improvement strategies by assessing individual and employer satisfaction of programs.Identifies and addresses quality issues. ü Obtains/maintains knowledge of Federal, State and Local funding and community resources available to patients and their families. ü Participates in continuing education (internal and external providers) in order to maintain clinical expertise. ü Conducts research as appropriate, to obtain/maintain knowledge of cultural differences including socioeconomic factors, cultural traditions, and spiritual beliefs. ü Assists in the implementation and adherence to policies, procedures, and new programs related to Utilization Management and Quality Improvement. ü Collaborates with other departments to promote coordination and communication within the Company regarding integration of administrative activities, quality improvement, and clinical operations. ü Ability to read and interpret Summary Plan Documents and other related resources relating to services requested. ü Performs all activities within the scope of licensure, certification, and Federal & State laws. ü Other duties and responsibilities as directed by supervisor. EXPERIENCE: ü Minimum of 3 years nursing experience in an acute care or relevant setting. ü Proficiency in basic computer skills including Microsoft Windows and Works (others as identified by supervisor), and the ability to access and navigate the Internet, to conduct research. ü Effective communication skills—verbal, written, interpersonal, and phone, in order to interact with internal departments and external contacts. ü Accurate spelling, grammar, and documentation preparation skills. ü Ability to attend to numerous details under the stress of maintaining courteous, accurate and timely relations with a variety of individuals. ü Ability to work independently, with minimal supervision. ü Ability to apply common sense understanding in carrying out detailed written or oral instructions. ü Ability to comprehend the consequences of various problem situations and to refer such problems to the appropriate individual (or supervisor) for decision-making. ü Ability to establish and maintain effective working relationships with co-workers and department managers, and medial providers. ü Ability to work with a wide range of personalities in a courteous, effective, and efficient manner, representing Bowers & Associates in a professional manner. EDUCATION: ü Licensed Practical Nurse with active and unrestricted license to practice in the State of Wisconsin. 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 or by sending an e-mail plete and accurate. Establishes and maintains patient profiles, prepares insurance claim forms, and stocks and takes inventory of prescription and over-the-counter medications. 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 or by sending an e-mail to accommodations@acs-.

Job Experience: Licensed Practical Nurse with active and unrestricted license to practice in the State of Wisconsin. Expected Travel Time: None