Utilization Review Nurse LVN

Prime Healthcare • Ontario, CA

1d • Onsite

About The Position

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0 million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Requirements

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

Nice To Haves

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

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.

Benefits

• paid time off
• a 401K retirement plan
• medical, dental, and vision coverage
• tuition reimbursement
• many more voluntary benefit options

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED