Company Info

TMG

1 S. Pinckney Street, Suite 320
Madison, WI, United States

Phone: 608-210-3629
Web Site: www.tmgwisconsin.com

Company Profile


Authorization LPN


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Job ID:

6070

Location:

Madison, WI, United States 

Category:

Health Care Services, Nurse
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Job Views:

1220

Zip Code:

53703

Employment Type:

Full time

Posted:

07.24.2019
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Job Description:

TMG by Magellan Health is seeking an Authorization Licensed Practical Nurse (LPN). The Authorization LPN is responsible for providing services to IRIS participants in the self-directed Personal Care program. The Authorization Registered Nurse works to ensure all the components of the Care Plan(prior authorization for services) matches with the physician order; reviews and approves all requests for addendums and ensures the Care Plan and Physician’s Orders are accurate. In addition, this position assists with audits and program quality and has responsibility for ensuring that there is not duplication of services between IRIS Self-Directed Personal Care (SDPC) and Medicaid Personal Care Services (MAPC).

Essential Functions

  • Review Care Plans, Physician Orders, and Personal Care Screening Tools (PCST) to ensure all components match and corrections are completed in a timely manner.
  • Approve and authorize services for individuals receiving IRIS personal care services.
  • Ensure proper transferring of the PCST when a participant leaves the program.
  • Ensure SDPC Representative, Physician, Nurse and Participant’s signatures are in place prior to services beginning,
  • Review and approve SDPC Addendum requests.
  • Review and monitor reports to ensure MAPC is not being billed if SDPC is in place, compliance and orders for services do not lapse.
  • Work with the SDPC Operations Manager and Data Team to complete monthly audits ensuring appropriate reporting is completed.  

Job Requirements:

  • Must possess and maintain an unrestricted Wisconsin LPN Licensure
  • 5+ years nursing experience with one year being home care nursing experience.
  • Strong understanding of Medicare and Medicaid rules, Personal Care Screening Tool and Long-Term Care Functional Screen.
  • Experience with home nursing assessments and knowledge of in-home care, risk associated with in-home care, equipment and service options available to participants.
  • Excellent written, verbal and listening skills.
  • Strong organizational, time management, prioritization.
  • Strong interpersonal and customer service skills to build relationships with a diverse population managing a variety of personal situations and issues.
  • Ability to be flexible, patient, creative and innovative in day-to-day operations and situations.
  • Ability to operate in an open, honest and forthright manner in order to build and maintain relationships and maintain strictest confidentiality.
  • Ability to focus on multiple priorities simultaneously and the ability to assess situations quickly and effectively using resources available, selecting a course of action and moving toward it.
  • Resourceful, proactive and detail-oriented; learn and incorporate new items quickly.
  • Ability to problem solve, troubleshoot and follow through/persevere as needed and appropriate.
  • Ability to remain calm and rational in high-pressure situations.
  • Work both collaboratively and independently, without close supervision, at a fast pace.
  • Ability to be responsive, empathetic, customer-focused and quality-driven.
  • Ability to be both persuasive and authoritative, depending upon the situation.
  • Ability to analyze data, draw appropriate conclusions and implement solutions.
  • Demonstrated computer and software skills required, proficiency with Microsoft Office Suite and database operation/maintenance skills and data entry experience.
  • Must possess a valid driver’s license, maintain adequate auto insurance for job-related travel, and ability to travel within Wisconsin and other states as necessary.