Prime Healthcare

Utilization Review Nurse LVN

Facility Prime Healthcare Management Inc
Location
US-CA-Ontario
ID
2022-103951
Category
LVN
Position Type
Full Time
Shift
Days
Job Type
Non-Exempt

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians. Fourteen 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!

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.

 

#LI-RK1

Qualifications

Education and Work Experience

 

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.



We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf

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