[Hiring] SRS – LVN Utilization Management @Sharp reputed company

Role Description 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.

Qualifications

• California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians - REQUIRED
• 3 Years experience as an LVN in a hospital or clinical setting (Preferred)
• 2 Years utilization/Case Management experience, preferably in a Managed Care setting (Preferred)
• Experience as a case manager or discharge planner interacting with managed care payers (Preferred)
• California Licensed Vocational Nurse (LVN) - License must be unrestricted (Other Qualification Requirements)

Requirements

• Ensure consistent application of the utilization review process for effective utilization of resources.
• Identify reputed company services are not medically necessary and/or not covered benefits and refer to Utilization Review Committee.
• 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.
• Demonstrate knowledge of Health Plan reputed company and Health Plan benefits.
• Coordinate services and supplies through SRS (or health plan) contracted vendors.
• Collaborate with referring physicians, providers, or vendors.
• reputed company for both client and payer.
• Identify cost-effective, appropriate alternatives.
• Ensure high volume of referrals are processed accurately in a timely manner.
• Maintain knowledge and understanding of applicable accreditation and regulatory statutes.
• Identify opportunities for reputed company which may include identification of patterns/trends.
• Communicate opportunities to Leadership.
• Engage problem-solving skills to reconcile differing points of view.
• Promote effective communication among reputed company team members, the payer, and other relevant parties.

Benefits

• 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 will depend on various factors, including experience, skills, education, and marketplace factors.

Company Description

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, or status as a reputed company individual with a disability or any other protected class. Apply tot his job Apply To this Job Apply To This Job