Utilization Review Nurse LVN
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At a glance
Requirements
Credentials this posting asks for.
Job overview
Prime Healthcare is hiring an Utilization Review Nurse LVN. Prime Healthcare, an award‑winning health system based in Ontario, California, seeks a Utilization Review Nurse LVN to coordinate referral processes, oversee staff productivity, train new employees, resolve vendor issues, and stay current with department policies and Self‑Funded Plan regulations.
Key focus areas include Coordinate daily referral distribution and tracking for Referral Technicians., Assist Director of UR Department in overseeing productivity of UR Coordinators and Referral Technicians., and Provide training to new staff on system and referral processes..
Successful candidates bring Active CA Licensed Vocational Nurse LVN License, 2+ Years Acute Hospital Case Management Experience, and Utilization Management Experience. Important skills include Interpersonal Relationship Skills, Professional Work Ethics, Active CA Licensed Vocational Nurse LvN License, Utilization Management, Professional And Hospital Claims, and Coding. Preferred (not required): Interpersonal Skills, Professional Ethics, Hospital Claims Knowledge, and Coding And Billing Knowledge.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Overview 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 3.0million 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!
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.
Qualifications Education and Work Experience
Required qualifications:
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Possess an active CA Licensed Vocational Nurse (LVN) license.
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Minimum (2) two years of experience in acute hospital case management or equivalent.
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Utilization Management experience required.
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Excellent interpersonal relationship skills with exceptional professional work ethics.
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Extensive knowledge of professional and hospital claims.
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Extensive knowledge of coding, billing.
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High School Diploma or GED Preferred qualifications:
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Experience and knowledge of Self-Funded plans, HMO plans, ERISA, and HIPAA guidelines.
Pay Transparency Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $71,760.00 to $99,590.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Employment Status Full Time Shift Days Equal Employment Opportunity Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Privacy Notice Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf
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