LVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr
About The Position
Current Emanate Health Employees - Please log into your Workday account to apply Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals. On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country. Job Summary The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews. You will document decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. 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.
Requirements
- Minimum of three years of utilization management experience.
- Experience in quality- related job preferred.
- Computer proficiency is required.
- Excellent customer service skills required.
- Current California LVN license.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
Number of Employees
1,001-5,000 employees
