LVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr

Company Name: Emanate Health

Employment Type: Full Time

Job ID: R0012362

Current Emanate Health Employees - Please log into your Workday account to apply

Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals.

On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country.

Job Summary

The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews. You will document decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings.

Job Requirements

Minimum Education Requirement:

Minimum Experience Requirement:

Minimum of three years of utilization management experience. Experience in quality- related job preferred. Computer proficiency is required. Excellent customer service skills required.

Minimum License Requirement:

Current California LVN license.

Delivering world-class health care one patient at a time.

Pay Range:

$31.03 - $46.54

Emanate Health is an Equal Opportunity Employer and does not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify the Human Resources Department by calling 626-858-8515.