[Hiring] LPN Clinical Research Coordinator @Arkansas Blue Cross Blue Shield

Role Description

LPN Clinical Research Coordinator organizes, analyzes, researches and manages complex programs, medical data and activities, which integrates multiple functional areas including:

• Case management
• Utilization management
• Disease management
• Health education
• Maternal child care management programs
• Closure of gaps in care

Qualifications

• High school diploma or equivalent required.
• Licensed Practical Nurse (LPN) with current active state license in the state(s) where job duties are performed required.
• Minimum four (4) years' clinical nursing experience, including a broad background in various facets of nursing.
• Knowledge of HCPCS/CPT/Revenue codes and general coding principles.
• Knowledge of claims processing rules/logic.
• Knowledge of Health Plan operations, regulatory agencies and State/Federal regulations related to health care.
• Minimum two (2) years' utilization review, medical policy, and/or case management experience required.
• Previous experience in appeals and/or grievances process preferred.

Requirements

• Excellent Oral & Written Communication
• Detail-Oriented
• Strong analytical, critical thinking, organizational and time management skills
• Proficiency using basic computer skills in Microsoft Office such as Word, Excel, Outlook, and PowerPoint
• Ability to make sound judgments and decisions based on facts and guidelines
• Ability to build collaborative relationships
• Ability to work independently with little supervision
• Ability to interpret complex documentation

Responsibilities

• Communication: Serves as a liaison facilitating a collaborative process between multiple internal functional areas, clinical leadership, primary physicians, patients, and Medical Director to assist with escalated cases that require input from multiple areas.
• Compliance: Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards, and individual state regulations.
• Data Analysis: Integrates data from multiple data sources or functional areas, ensures data accuracy and integrity, and updates data as needed.
• Knowledge: Remain current with up-to-date medical and surgical procedures, products, healthcare services and drugs, and general trends in health care delivery.
• Other duties as assigned.
• Participant: Serves on various committees and project teams related to policy changes, system enhancements, process improvement initiatives, etc.
• Process Improvement: Monitors and evaluates data and processes to ensure accuracy and identify changes to increase efficiency and effectiveness.
• Researcher: Serves as a resource to Medical Director(s) and Care Management team providing analysis, reporting, and research on medical conditions, medical terminology, medications, lab work, medical records, healthcare processes, coverage policies, plan guidelines, and/or health/wellness.

Certifications

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained.

Employment Type

Regular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.