This is a full-time position with a hybrid remote work arrangement in our Sheboygan, WI location. No weekends, holidays or on-call rotations.
Prairie States Enterprises, Inc.
is a third party administrator, a benefits industry leader, and a trusted advisor to self-insured companies and their employees. We provide a complete range of medical benefit management services, all performed in-house, and to exacting standards of excellence.
As a result of our continuing growth, we are seeking an experienced LPN
to join our PSE Health Management Team in the position of a Utilization Management - Licensed Practical Nurse.
We seek professionals
who share our passion in striving to improve the health status and benefit plan experience of our clients and their employees.
The Licensed Practical Nurse works under the direction of the RN to assist in the administration of the members benefit plan.
SUMMARY OF ESSENTIAL JOB FUNCTIONS
• Develops and uses proficient knowledge of Prairie States Enterprise book of business for administering our Groups’ Plan Documents including but not limited to specific Medical Plan needs, internal requirements/initiatives, networks, pharmacy benefit managers, and customer quality initiatives
• Competently/proficiently completes pre-certification process for: Inpatient, Outpatient services, and Durable Medical Equipment
• Assists RN’s with pre-certifications, concurrent, retro reviews, and other delegated activities as appropriate
• Proficiently/efficiently utilizes Acuity Software and other internal resources such as claims and member dashboard in the completion of pre-certifications
• Complete timely and accurate authorizations for cases within the LPN Scope of Practice
• Forefront of customer service representation for Health Services. Must ensure proper phone etiquette, warm transfers, and knowledge of resources
• Effective communication with a variety of sources such as claims staff, UM RN’s, CM RN’s, providers, members, customers, vendors, and account management
• Assist in the review and implementation of new customers specific to pre-certification, medical benefits, and exclusions
• Participation/attendance to scheduled staff meetings and other councils/committees as assigned
• Ensure/assist in timely follow-up per internal/external requirements such as faxing, developing and mailing letters, and return of communications to outside sources.
• Education – Degreed as a LPN with current licensure in good standing.
• 3+ years of experience in a clinical or hospital setting
• Adherence to the Scope of Standards of Practice for the LPN
• Effective communication skills including oral, nonverbal, and written
• Ability to work collaboratively with the Health Management Team
• Strong organizational skills
• Ability to work collaboratively with diverse individuals
• Must have a basic computer skills and ability to learn new computer programs
• Require past experience in clinical or hospital setting
• Adherence and application of HIPAA regulations
• Computer Skills: Word, Excel, Microsoft Outlook, keyboarding and data entry
• Telephone etiquette
• Must be able to carry positive conversations with medical providers and members to facilitate understanding by all parties
REQUIRED COMPETENCIES (required for successful performance)
• Change Management – Accepts, supports, and executes assignments in conditions of change which support attaining department goals.
• Effective Communication – Demonstrates effective and responsive communications following the appropriate reporting structure.
• Accountability/Results – Achieves and/or exceeds result based goals that were specific, measurable, and timely.
• Teamwork – Demonstrates teamwork behaviors and makes positive contributions and which support the achievement of department goals.
• Customer Satisfaction – Dedicated to the PSE service model and meets or exceeds PSE customer satisfaction expectations in providing exemplary service.
• Professional Growth – Takes ownership of one’s professional growth within one’s current position and to advancement at PSE.
This is sedentary position which requires the individual to sit for long periods of time and the proper positioning/posturing for extensive viewing of computer screens and computer related work is required. It is encouraged that individuals intermix this sedentary time with periodic movement within one’s office space and/or to other office areas to counteract the sedentary nature of this position.
To the selected candidate, we offer:
- Competitive compensation based on experience and a comprehensive benefit package provided to include Medical, Dental, Vision, Life, STD/LTD, FSA, Paid Time Off, personal days, 401k with match, wellness and exercise membership and more. Click HERE to view our full-time benefits flyer.
- Opportunity for meaningful career growth within a results-driven company and our company culture is one of ambition, integrity, empowerment, teamwork and a passion for personal and company success.
If this sounds like you and you’re seeking career growth with an exciting new career path in overseeing the quality of health care for our clients and their members, please send your cover letter and resume following the instructions for this site.
Prairie States Enterprises
Equal Opportunity Employer