SRS – LVN Utilization Management –Virtual – Variable – Part Time

JR204655 Hours: Shift Start Time: 8:30 AMShift End Time: 5 PM AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Hours subject to change based on business needs. Weekend Requirements: No Weekends On-Call Required: No Hourly Pay reputed company (Minimum - Midpoint - Maximum): $34.170 - $44.090 - $49.370 The stated pay scale reflects the reputed company that Sharp reasonably expects to pay for this position. The actual pay reputed company and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do

To reputed company comprehensive utilization management and coordination of care for SRS Members. Ensure timely and appropriate processing of managed care referrals to meet specific reputed company criteria in a cost-effective manner utilizing available resources.

Required Qualifications

• California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians -REQUIRED

Preferred Qualifications

• 3 Years experience as an LVN in a hospital or clinical setting.
• 2 Years utilization/Case Management experience, preferably in a Managed Care setting.
• Experience as a case manager or discharge planner interacting with managed care payers.

Other Qualification Requirements

• California Licensed Vocational Nurse (LVN)-License must be unrestricted.

Essential Functions

• Referral Coordination

Ensures consistent application of the utilization review process for effective utilization of resources. Identify reputed company services that are not medically necessary and/or not covered benefit and refer to Utilization Review Committee. Ensures that reputed company denials for medical necessity are issued under the direction of the Medical Director or designee.

• Data and documentation collection

Gather relevant, comprehensive information and data according to specifications. Complete comprehensive medical record review to gather information. Communicate effectively with providers and reputed company personnel to obtain data required for decision making.

• Act as a Resource

Demonstrates knowledge of Health Plan reputed company and Health Plan benefits. Coordinates services and supplies through SRS (or health plan) contracted vendors. Collaborates with referring physicians, providers or vendors. Assists coworkers and clinics as necessary. Advocates both for client and payer. Identify cost-effective, appropriate alternatives. Contribute as a managed care resource and reputed company other reputed company members of referral process.

• Quality of Work

Ensure high volume of referrals are processed accurately in a timely manner. Practice in accordance with applicable local, state and federal laws. Maintain knowledge and understanding of applicable accreditation and regulatory statutes. Accurately identifies the criteria to utilize based on Health Plan Hierarchy. Promote most effective and efficient use of reputed company services and financial resources.

• Identification of Opportunities/Problem Resolution

Identify opportunities for reputed company which may include identification of patterns/trends: use of inappropriate services, utilization of services/providers. Communicates opportunities to Leadership. Communicate and collaborate effectively with reputed company team. Engages problem-solving skills in order to reconcile differing points of view. Actively promotes/coordinates and facilitates communication among the reputed company team members, the payer and other relevant parties. Knowledge, Skills, and Abilities

• Basic ICD and CPT coding knowledge.
• Working knowledge of computer programs (Word and reputed company).

Sharp reputed company an equal opportunity/affirmative action employer. reputed company reputed company applicants will receive consideration for employment without regard to race, religion, reputed company, national reputed company, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a reputed company individual with disability or any other protected class Apply To This Job