Utilization Review Nurse LVN - CareConnect in Lynwood, CA at Prime Healthcare

Date Posted: 2/10/2021

Job Snapshot

Job Description

Responsibilities Responsible for the daily navigation of members transferring into and out of the medical center. Communication with hospital departments and outside health insurers, including hospitals, health plans, IPA, medical groups. Coordination with internal hospital departments. Provides training to new staff when necessary, on system and referral processes. Assists physician, offices and vendors with problem resolution. Responsible for clinical review for patients.  Knowledgeable in policies, procedures and practices and keeps updated with regulations applicable to the department including applicable regulations. 



  1. Possess an active CA Licensed Vocational Nurse (LVN), required
  2. Minimum (2) two years’ experience in acute hospital case management or equivalent, required
  3. Excellent interpersonal relationship skills with exceptional professional work ethics.
  4. High School Diploma or GED, required
  5. Experience and knowledge of Self-Funded plans, HMO plans, ERISA, and HIPAA guidelines, preferred
  6. Knowledge in IPA, Medical Group and capped arraignments preferred
  7. Utilization Management experience preferred.
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