Utilization Review Nurse LVN

About the position

The Utilization Review Nurse LVN position at Prime Healthcare involves overseeing and coordinating referral processes within the Utilization Review Department. The role requires collaboration with various stakeholders, including referral technicians and physician offices, to ensure efficient management of patient referrals and compliance with relevant regulations. The position is integral to maintaining high standards of patient care and operational efficiency within the healthcare system.

Responsibilities
? Coordinate and oversee the daily activities of Referral Technicians regarding referral distribution and tracking.
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? Assist the Director of the Utilization Review Department in monitoring the productivity of UR Coordinators and Referral Technicians.
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? Provide training to new staff on system and referral processes.
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? Assist physician offices and vendors with problem resolution.
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? Stay updated on policies, procedures, and regulations applicable to the department.

Requirements
? Possess an active CA Licensed Vocational Nurse (LVN) license.
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? Minimum of two years of experience in acute hospital case management or equivalent.
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? Utilization Management experience required.
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? Excellent interpersonal relationship skills with strong professional work ethics.
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? Extensive knowledge of professional and hospital claims, coding, and billing.

Nice-to-haves
? Experience and knowledge of Self-Funded plans, HMO plans, ERISA, and HIPAA guidelines.

Benefits
? 401(k)
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? Dental insurance
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? Health insurance
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? Paid time off
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? Tuition reimbursement
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? Vision insurance

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