LVN - Inpatient Utilization Review Nurse - SRS Copley - Days - FT
Company: SHARP HEALTHCARE
Location: San Diego
Posted on: April 24, 2024
|
|
Job Description:
HoursShift Start Time:8 AMShift End Time:4:30 PMAdditional Shift
Information:Weekend Requirements:No WeekendsOn-Call
Required:NoHourly Pay Range (Minimum - Midpoint - Maximum):$31.495
- $40.639 - $49.783 -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. - -
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 specific healthcare criteria in a
cost-effective manner utilizing available resources.
Required Qualifications
Preferred Qualifications
Other Qualification Requirements
Essential Functions
Ensures consistent application of the utilization review process
for effective utilization of resources.
Identify when services that are not medically necessary and/or not
covered benefit and refer to Utilization Review Committee. Ensures
that all denials for medical necessity are issued under the
direction of the Medical Director or designee.
Gather relevant, comprehensive information and data according to
specifications.
Complete comprehensive medical record review to gather
information.
Communicate effectively with providers and healthcare personnel to
obtain data required for decision making.
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.
Assists coworkers and clinics as necessary.
Advocates both for client and payer.
Identify cost-effective, appropriate alternatives.
Contribute as a managed care resource and educate other healthcare
members of referral process.
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.
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
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, status as
a protected veteran, among other things, or status as a qualified
individual with disability or any other protected class
California Licensed Vocational Nurse (LVN) - CA Board of Vocational
Nursing & Psychiatric Technicians
Keywords: SHARP HEALTHCARE, Coachella , LVN - Inpatient Utilization Review Nurse - SRS Copley - Days - FT, Other , San Diego, California
Click
here to apply!
|