Join to apply for the LVN Utilization Review - SRS Inpatient Case Management - Copley - Days - FT role at Sharp HealthCare
Hours : Shift Start Time 9 AM; Shift End Time 5 : 30 PM
AWS Hours Requirement : 8 / 40 - 8 Hour Shift
Additional Shift Information : Hours may vary based on dept. need
Weekend Requirements : No Weekends
On-Call Required : No
Hourly Pay Range (Minimum - Midpoint - Maximum) : $33.090 - $42.700 - $52.310
The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate 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.
Please Note : As part of our recruitment process, you may receive communication from Dawn, our virtual recruiting assistant. Dawn is designed to support scheduling for screening calls and interviews, helping to ensure a smooth and timely experience. Please be assured that all candidate evaluations and hiring decisions are made by our recruitment and hiring teams.
What You Will Do
To provide comprehensive utilization management and coordination of care for SRS Members. Ensure timely and appropriate processing of managed care referrals to meet healthcare 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. Identifies when services are not medically necessary and / or not covered benefits and refers to the Utilization Review Committee. Ensures that denials for medical necessity are issued under the direction of the Medical Director or designee.Data and documentation collection : Gather relevant information and data; complete comprehensive medical record reviews; communicate effectively with providers and healthcare personnel to obtain data required for decision making.Act as a Resource : Demonstrates knowledge of Health Plan contracts and Health Plan benefits. Coordinates services and supplies through SRS (or health plan) contracted vendors. Collaborates with referring physicians, providers or vendors. Advocates for client and payer. Identify cost-effective, appropriate alternatives. Contribute as a managed care resource and educate other healthcare 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 healthcare services and financial resources.Identification of Opportunities / Problem Resolution : Identify opportunities for intervention which may include identification of patterns / trends : use of inappropriate services, utilization of services / providers. Communicates opportunities to Leadership. Communicate and collaborate effectively with healthcare team. Engages problem-solving skills in order to reconcile differing points of view. Actively promotes / coordinates and facilitates communication among the healthcare team members, the payer and other relevant parties.Knowledge, Skills, And Abilities
Basic ICD and CPT coding knowledge.Working knowledge of Word and Excel.Sharp HealthCare is an equal opportunity / affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, protected veteran status, disability status, or any other protected class.
Seniority level
Mid-Senior levelEmployment type
Full-timeJob function
Health Care ProviderIndustries
Hospitals and Health CareJ-18808-Ljbffr