Location & Practice Overview

The role is located in Newark, New Jersey and operates inside a managed-care utilization management setting that centers on post-service claim and medical-record review.

City & State Newark, New Jersey
Practice Type Managed-care utilization management
Review Model Retrospective medical-record and claim evaluation
Service Context Staffing placement with a healthcare organization

Responsibilities

  • Review medical records against specified guidelines while factoring in patient age, time of day, injury severity, and resource availability.
  • Document the clinical findings of each case and clearly state the reasoning that supports the final determination.
  • Handle all phases of the reconsideration process and confirm eligibility, timeliness, and completeness of ER PLP cases.
  • Enter claim-detail information into organizational systems and contact providers when records need follow-up.
  • Help resolve provider questions and coordinate with Claims and Appeals departments as needed.
  • Support process-development efforts, test new workflows, check data accuracy, and complete assigned ad-hoc clinical record evaluations.

Qualifications & Requirements

The position requires current New Jersey licensure and demonstrated experience in utilization review within a managed-care environment.

State License
Clear and active LPN license issued by the state of New Jersey
Utilization Experience
1–2 years of Utilization Review or Utilization Management experience
Managed-Care Background
Prior experience working in a managed-care setting
Clinical Interpretation
Ability to assess clinical notes and apply guideline-based criteria

Compensation & Benefits

Pay is negotiable according to experience and is offered within the published hourly range. Confirmed benefits center on health coverage and flexible deposit options.

  • Hourly compensation: $27–$36.50
  • Medical, dental, and vision insurance
  • Weekly deposit pay options

Schedule & Work Environment

Workdays Monday through Friday
Daily Hours 8:00 a.m. to 5:00 p.m.
Status Full-time
Schedule Pattern Standard weekday daytime hours

Patient Population & Clinical Setting

The work involves retrospective examination of claim and medical-record documentation rather than direct patient encounters. Cases frequently involve emergency-related presentations and vary by age, injury severity, and clinical complexity.

Case Type ER PLP and related utilization cases
Documentation Source Provider-submitted clinical notes and records
Acuity Range Variable severity of injury and clinical presentation
Interaction Level Record-based review without real-time patient contact

Clinical Focus & Key Services

The professional core of the position is the application of utilization guidelines to completed medical records in order to support accurate claim determinations.

Guideline Application Matching clinical documentation to established utilization criteria
Determination Documentation Clear clinical rationale for each claim outcome
Reconsideration Support Full-cycle participation in the reconsideration process
Data Accuracy Verification of clinical data entry and output integrity

Role Highlights

This LPN opportunity differs from traditional clinical nursing by focusing exclusively on post-service record evaluation and claim-support activities inside a managed-care framework.

  • Exclusive concentration on retrospective review rather than concurrent or prospective utilization activities
  • Active role across every stage of the reconsideration process with direct Claims and Appeals collaboration
  • Involvement in process-development and workflow-testing projects beyond routine case review
  • Consistent weekday daytime schedule without bedside shift rotation or weekend clinical coverage

About HealthCare Support Staffing

HealthCare Support Staffing is a national niche recruitment firm founded in 2002 and headquartered in Maitland, Florida. The company places clinical and non-clinical professionals with health plans, hospitals, pharmacies, laboratories, surgery centers, and other healthcare organizations across the United States. It is part of the Ingenovis Health family of brands.

Organization Type National healthcare recruiting and staffing firm
Year Founded 2002
Headquarters Maitland, Florida
Parent Organization Ingenovis Health family of brands
Placement Scope Clinical, non-clinical, and administrative healthcare roles nationwide

Frequently Asked Questions

Does this role involve direct patient care?
No. The position is dedicated to retrospective review of medical records and clinical notes for utilization and claim determinations. There is no real-time patient interaction.
What are ER PLP cases in the context of this job?
The posting specifically requires verification of eligibility, timeliness, and record completeness for ER PLP cases, with follow-up to providers when documentation is incomplete. The acronym is not further defined in the available description.
How much utilization-management experience is needed?
Candidates must have 1–2 years of Utilization Review or Utilization Management experience plus prior managed-care experience and an active New Jersey LPN license.
What is the published work schedule?
The position follows a Monday-through-Friday schedule from 8:00 a.m. to 5:00 p.m. No additional weekend or evening requirements appear in the posting.
Will the LPN work with Claims and Appeals teams?
Yes. Responsibilities include assisting with provider-issue resolution and maintaining communication with internal Claims and Appeals departments.
Is there involvement in process improvement?
Yes. The role includes participation in process development, testing of new workflows, and ad-hoc clinical record evaluation projects directed by the manager or director.

Retrospective Review LPN in Newark, NJ

This full-time Retrospective Review LPN position in Newark, New Jersey focuses on post-service evaluation of medical records inside a managed-care utilization management environment. Candidates need an active New Jersey LPN license, one to two years of utilization review or utilization management experience, and prior managed-care background. Core activities include applying established guidelines to clinical documentation, recording the clinical rationale for each determination, managing all phases of the reconsideration process, verifying completeness of ER PLP cases, entering claim details into organizational systems, and coordinating with Claims and Appeals teams. The published schedule is Monday through Friday from 8:00 a.m. to 5:00 p.m. Compensation is offered at $27–$36.50 per hour and includes medical, dental, and vision coverage together with weekly deposit options. HealthCare Support Staffing, a national healthcare recruiting firm founded in 2002 and headquartered in Maitland, Florida, places qualified LPNs into this non-bedside clinical-review role that supports accurate claim outcomes and data integrity.

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