Medical Receptionist

Common Spirit • Rancho Cordova, CA

338d • Hybrid

About The Position

Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. As an affiliate of Dignity Health, one of the largest health systems in the nation, we provide comprehensive health care services to the communities we serve. Our focus is on creating purposeful work settings where staff can provide excellent care while advancing in knowledge and experience. The Utilization Review (UR) LVN plays a crucial role in providing utilization management services, ensuring high-quality, cost-effective care for patients. This position is hybrid, involving both in-office/clinic and work-from-home responsibilities.

Requirements

• 3 years Utilization Management (UM) experience.
• 5 years LVN experience.
• Clear and current CA LVN license.
• Knowledge of health plans, medical specialty procedures, and diagnoses.
• Strong knowledge of nursing requirements in a clinical setting.
• Knowledge of utilization management programs as related to pre-set protocols and criteria.
• Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and meeting deadlines.
• Ability to apply clinical judgment to complex medical situations and make quick decisions.
• Ability to read and interpret benefit contract specifications.
• Ability to understand and follow established criteria and protocols used in managed care functions.
• Strong organizational skills.
• Effective telephone and computer data entry skills required.
• Ability to formulate ideas and solutions into appropriate questions and assess/interpret the verbal responses.

Nice To Haves

• General knowledge of UM and Managed Care preferred.
• Use of InterQual guidelines preferred.
• Experience at meeting deadlines by prioritizing work flow preferred.
• Physician group experience preferred.
• Knowledge of California health plans and differences between commercial and advantage plans preferred.
• Familiarity with business practices and protocols with ability to access data and information using automated systems preferred.
• Ability to communicate effectively with coworkers, members, their families, physicians, and health care providers preferred.

Responsibilities

• Conducts pre-authorization referral reviews following workflow as written document criteria to make determination or recommendation and process the referral in a timely manner.
• Supports the quality programs within the Department through participation in projects, reviews, and compliance with policies and practices.
• Provides appropriate support to co-workers, leaders, physicians, referral sources, and other departments during all work activities.

What This Job Offers

• Industry: Water Transportation