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Company: CTG
Location: Provo
Posted on: June 9, 2021

Job Description:

LPN Reviewer

United States

Information Technology

May 17, 2021Post Date

21202074Requisition #

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CTG is seeking aLPN Reviewer. This a remote position that requires a current, unrestricted CA LPN license.

Location: Remote (must have unrestricted California LPN license)

Duration: 3+ months


The LPN Reviewer is responsible for performing clinical reviews of precertification requests for admissions, services, procedures, or equipment.

Job Specifics Include:

* Receives precertification requests for approval of admission, service, procedure, or equipment through fax, Web, or client specified MMIS system

* Reviews requests by collecting additional data, applying appropriate clinical criteria (MCG or InterQual) and using clinical expertise to approve request or refer to physician for decision

* Clearly writes clinical rationale for approval of request or referral to physician

* Answers provider questions as required to complete review of request

* Enters clinical decision in review application or client MMIS system

* Formats and edits approval and denial letters as required by client

Experience in the following is recommended:

* Application of criteria sets such as MCG Criteria, LCD/NCD and Apollo

* UM for Medi-Cal and Medicare LOB

* DME and OON line of review

Basic Qualifications:

* Current, unrestricted California LPN license

* Prior Authorization review experience required

* Ability to communicate both verbally and in writing fluently in English.

* Ability to work proficiently with Microsoft Word, Excel, and Power Point.

* Ability to analyze and evaluate medical information.

* Ability to provide good customer service skills.

* Ability to sit and work at a computer for an extended period of time.

* Average manual dexterity in use of a PC, phone, sorting, filing and other office machines.

* Ability to perform well in team environment, with staff at all levels, to achieve business goals.

* Ability to function under pressure and with deadline oriented project demands as well as manage multiple initiatives.

* Ability to apply existing knowledge of health care marketplace including commercial and government insurance healthplan organizations and HIPAA guidelines with their associated security requirements.

* Ability to work independently to meet predefined production and quality standards.

* Working knowledge in and successful application of clinical review.

* High School Diploma or GED required

* Successful completion of an accredited LPN educational program required

* Current, unrestricted LPN/LVN license

* 2+ years diverse, acute care clinical experience

* 1+ year utilization review experience

CTG does not accept unsolicited resumes from headhunters, recruitment agencies, or fee based recruitment services for this role.

To Apply:

To be considered, please apply directly to this requisition using the link provided. For additional information, please contactRoberta Allegrino at 888-284-6551 ext. 2113 or Kindly forward to any other interested partiesthank you!

CTGs Benefits Plan allows you to select insurance coverage that best suits your lifestyle, and take part in our savings programs and educational plans. We offer Flexible Spending Accounts, a 401(k) Retirement Plan, and an Employee Stock Purchase plan. Our educational plan comprises access to more than 2,000 web-based technical, professional and business development courses.

CTG is a leading provider of digital transformation solutions and services that accelerate clients' project momentum and achievement of their desired IT and business outcomes. Our vision is to be an indispensable partner to our clients and the preferred career destination for digital and technology experts. CTG has operations in North America, South America, Western Europe, and India. For more information, visit

Our culture is a direct result of the people who work at CTG, the values we hold, and the actions we take. In other words, our people are the culture. It's a living, breathing thing that is renewed every day through the ways we engage with each other, our clients, and our communities. Part of our mission is to cultivate a workplace that attracts and develops the best people, reflected by our recognition as a Great Place to Work-certified company across many of our global operations.

CTG will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of all applicable local, state, and federal laws.

CTG is an Equal Opportunity and Affirmative Action Employer. CTG will assure equal opportunity and consideration to all applicants and employees in recruitment, selection, placement, training, benefits, compensation, promotion, transfer, and release of individuals without regard to race, creed, religion, color, national origin, sex, sexual orientation, gender identity and gender expression, age, disability, marital or veteran status, citizenship status, or any other discriminatory factors as required by law. Our Affirmative Action program serves to promote occupational equality and diversity through good faith efforts. CTG is fully committed to promoting employment opportunities for members of protected classes.

Additional Information

* Job Function: Healthcare & Hospital Implementations

* Education Level: High School Diploma/GED (11 years)

* Work Remote: Yes

* Travel: No

Keywords: CTG, Provo , LPN, Other , Provo, Utah

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