LPN - Medical Review - Remote

CEI • Contractor • Remote (Columbia, South Carolina, United States) • $0 / year • 21h ago

Job DescriptionJob DescriptionLPN - Medical ReviewJob at a GlanceTitle: LPN - Medical ReviewLocation: Columbia, SC (remote after 1–2 weeks of onsite training; local candidates only; onsite as needed for meetings/training)Contract: W2 onlyPay: $ 23 /hour and optional medical, dental, vision, 401(k) matchMust live within 2 hours of Columbia, SCMust have an active LPN LicenseOverview Join a clinical review team supporting utilization management and medical reviews for professional, inpatient/outpatient, facility services, and appeals. In this role, you will apply established criteria and clinical guidelines to document determinations, support authorizations, and ensure timely, accurate decisions. This is a contract opportunity with an initial onsite training period followed by remote work.Key ResponsibilitiesPerform medical reviews and utilization management using established criteria sets and clinical guidelinesReview clinical documentation for pre-certifications (e.g., DME, home healthcare, elective procedures) and document determinations per protocolSupport authorization processes to confirm coverage and medical necessity within benefit guidelinesReview medical information and interdepartmental requests in a timely manner to complete utilization workflowsProvide accurate, timely written documentation and communications to members and providers regarding determinationsEducate internal/external stakeholders on medical review processes, medical terminology, and coverage/coding practicesParticipate in required training and quality control activities to support team and organizational objectivesRequired SkillsStrong understanding of medical terminology and clinical documentation reviewAbility to apply clinical guidelines/criteria sets to support coverage and medical necessity determinationsAnalytical and critical thinking skills with sound judgmentDemonstrated customer service, organization, and attention to detailProficiency with word processing and computer-based workflowsStrong written communication skills (spelling, punctuation, grammar)Ability to handle confidential and sensitive information with discretionAbility to adapt to changing workloads and collaborate in a supportive team environmentEducationGraduate of an accredited school of Licensed Practical Nursing (LPN) / Licensed Vocational Nursing (LVN)Preferred SkillsAssociate degree in Nursing OR graduate of an accredited school of NursingExperience supporting utilization management, authorizations, or medical necessity review workflowsAbility to educate peers or stakeholders on review processes and clinical documentation standardsWhy Should I Apply? If you enjoy applying clinical expertise to structured guidelines and delivering clear, well-documented determinations, this role offers a strong opportunity to contribute in a collaborative clinical review environment.About CEI: As a trusted technology partner, CEI delivers solutions that help our customers transform their business and achieve meaningful results. From strategy and custom application development through application management - our technology and digital experience services are tailored to meet each unique need of our customers. Our staffing solutions bring specialized skills to complement our customers' workforce and project requirements.#ZR #INDGEN