Utilization Review Nurse LVN - PHMI EE Benefits

Company: Prime Healthcare
Location: Lynwood
Posted on: January 12, 2021

Job Description:

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-RK1Qualifications Education and Work ExperienceRequired qualifications:- 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 GEDPreferred qualifications:- 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

Keywords: Prime Healthcare, Lynwood , Utilization Review Nurse LVN - PHMI EE Benefits, Other , Lynwood, California