Medical Reviewer (LPN)

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place.

Job Description:

Medical Reviewer (LPN)

Remote

The Medical Reviewer collects appropriate medical records, performs medical record reviews related to billing compliance, and submits records to payers, as requested.  The incumbent analyzes submitted claims and/or claims to be submitted as well as medical records to determine benefit coverage for medical services under review.  This position prepares written documents and/or reports of completed medical review determinations and submits records to the payer, as requested.

At Elara Caring, we care where you are and believe the best place for your care is where you live. We know there’s no place like home, and that’s why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their health journey, we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as a Medical Reviewer by keeping a team of elite healthcare professionals operational.

To continue to be an industry pioneer delivering unparalleled care, we need a Medical Reviewer who shares our commitment to distinction and progress. Are you one of them? If so, apply today!

Why Join the Elara Caring mission?

• Work in a collaborative environment.
• Be rewarded with a unique opportunity to make a difference
• Competitive compensation package
• Tuition reimbursement for full-time staff and continuing education opportunities for all employees at no cost
• Opportunities for advancement
• Comprehensive insurance plans for medical, dental, and vision benefits
• 401(K) with employer match
• Paid time off, paid holidays, family, and pet bereavement
• Pet insurance

What is Required?

• Graduated with a diploma from an accredited school as a Licensed Practical Nurse or Licensed Vocational Nurse is required
• Current license as a Licensed Practical Nurse or Licensed Vocational Nurse is required
• 3 years of experience as a licensed practical nurse or licensed vocational nurse in a home health and/or hospice clinical care setting is required
• Prior functional working experience in the medical review arena (Utilization Review, Case Management, and knowledge of appropriate billing and coding guidelines) is preferred
• Demonstrated communication, negotiation, critical thinking, and organizational skills
• Ongoing understanding of current Medicare, Medicaid, and third-party regulations as changes occur
• Knowledge in all levels of home health, hospice, palliative, and home medical equipment practices
• Advanced computer skills with proven ability to multitask effectively across dual-screen environments.

You will report to the Pre-Claim Supervisor.

This is not a comprehensive list of all job responsibilities