Pamela Hopper, LVN

Issued prior authorization for out-pt procedures, inpatient admissions, ARU, SNF and DME.

MCG care guidelines.

• Documented accurate and complete patient information. Administered COVID vaccines.

• Performs prospective, concurrent and retrospective utilization reviews and first-level determination approvals for members using evidenced-based guidelines, policies and nationally recognized clinical criteria across lines of business or for a specific line of business such as HMO, PPO, POS, and MediCare. Reviewed for SNF, Home Health, Acute Rehab, and DME.
• Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings.

• Documented patient vitals, behaviors and conditions to communicate concerns to supervising charge nurse.
• Administered medications, treatments, wound care and other services.