An independent subsidiary of WellPoint, Inc, National Government Services (NGS) is one of the largest Medicare contractors in the country, serving nearly 200,000 providers and suppliers and over 20 million customers with Medicare in 20 states and five U.S. territories. Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine. *Position will be able to telecommute after training* Our NGS Nurse Reviewer LPN works with healthcare providers to help ensure appropriate and consistent administration of plan benefits through collecting clinical information required to assess medical necessity, out of network services, and appropriateness of treatment setting and applying appropriate medical policies, clinical guidelines, plan benefits, and scripted algorithms within scope of licensure. Primary duties may include, but are not limited to:
Requires a minimum of an LPN or LVN with current licensure or certification in the appropriate state and 2 years clinical experience, recent utilization review experience or any combination of education and experience, which would provide an equivalent background. Knowledge of the medical management process preferred.
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