Utilization Review Nurse LVN - Benefits in Ontario, CA at Prime Healthcare

Date Posted: 9/13/2020

Job Snapshot

Job Description

Responsibilities Responsible for the daily coordination and oversight to the Referral Technicians with regard to referral distribution and tracking. Assists Director of UR Dept. in providing oversight and monitoring productivity of UR Coordinators and Referral Technicians. Provides training to new staff on system and referral processes. Assists physician offices and vendors with problem resolution. Knowledgeable in policies, procedures and practices and keeps updated with regulations applicable to the department including applicable regulations pertinent to Self-Funded Plan.

 

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Required qualifications:

  1. Possess an active CA Licensed Vocational Nurse (LVN) license.
  2. Minimum (2) two years of experience in acute hospital case management or equivalent.
  3. Utilization Management experience required.
  4. Excellent interpersonal relationship skills with exceptional professional work ethics.
  5. Extensive knowledge of professional and hospital claims.
  6. Extensive knowledge of coding, billing.
  7. High School Diploma or GED
Preferred qualifications:

  1. Experience and knowledge of Self-Funded plans, HMO plans, ERISA, and HIPAA guidelines.


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