Medical Reviewer LPN

Position Overview

At HCSC, our employees are the cornerstone of our business and the foundation of our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC to be part of a purpose-driven company that invests in your professional development.

Job Summary:

Key Responsibilities

• Responsibilities: Conduct pre-authorization reviews in accordance with medical contracts, regulations, and established criteria ensuring quality utilization review and care.

Required Qualifications

• LPN with a valid, current, unrestricted clinical license in the state of operations.
• 3 years of clinical experience in a physician office, hospital, or surgical setting.
• Customer service orientation to assist internal/external customers.
• Strong verbal and written communication skills.
• Excellent interpersonal skills and the ability to be a team player.
• Willingness and ability to travel.
• Familiarity with PC or database systems.
• For incumbents with nursing licenses in positions requiring multi-state licensure, the ability to obtain and maintain additional valid licenses as determined by management.

Preferred Qualifications

• Utilization review or utilization management experience.
• Insurance industry experience.

Benefits & Perks

• Benefits: Enjoy a robust total rewards package that includes health and wellness benefits, a 401(k) savings plan, a pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, an employee assistance program, paid holidays, tuition reimbursement, and additional incentives.