Utilization Management - LPN

COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs, and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

SUMMARY DESCRIPTION:

Utilizes clinical skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. Requires an LPN with unrestricted active license.

ESSENTIAL FUNCTIONS:

• Promotes/supports quality effectiveness of healthcare services and benefit utilization
• Utilizes clinical skills to support coordination, documentation, and communication of medical services
• Collects information to support the process of rendering appropriate medical necessity/benefit determinations
• Identifies members for referral to the care management team
• Utilizes clinical experience, criteria/guidelines, policies, and procedures in support of making timely and accurate medical necessity/benefit determinations
• Completes Health Risk assessments-both initial and annual for selected members
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Enhancement of medical appropriateness and quality of care using a holistic approach including but not limited to consults with case managers, supervisors, Medical Directors, and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.

QUALIFICATIONS AND REQUIREMENTS:

• 2-3 years of experience in utilization management
• Confidence working as an independent thinker, using tools to collaborate and connect with teams virtually
• LPN with an unrestricted license
• Analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills
• Ability to work independently
• Effective computer skills including navigating multiple systems
• Proficiency with standard corporate software applications, including Outlook, MS Word, Excel, as well as some proprietary applications

Preferred Qualifications

• 2 years working in managed care setting preferred

 HC80-30-202