Job Details

Utilization Review Lvn

CHOC's Care Management team is looking for an experienced Utilization Review LVN to cover weekends (Sat/Sun) 8am-5pm. Additional hours during the week (8am-4:30pm) may be available/requested. Our Per Diem Associates will also need to cover some holidays. The Utilization Review Representative is responsible for utilization review of all inpatient and outpatient statuses. This individual is also responsible for the daily processing of internal and external authorization requests with payors for treatments, services, and supplies in collaboration with the RN Care Managers Inpatient and Outpatient. Will assist in the completion of the RN Care Manager's case load as assigned, promoting a positive approach to all activities related to data collection, insurance verification, financial counseling and customer service. This role ensures that the work processed is accurate and complete in all areas of responsibilities. The qualified candidate will have Utilization Review experience in an Acute Care, Sub-Acute/SNF/LTAC, Health Plan or IPA setting.

Pay Range: Minimum $29.48 Midpoint $39.04 Maximum $48.61

Rate of pay is determined by various factors, including but not limited to knowledge, skills, competencies, experience, education, as well as position requirements.

Experience

Required: 2 years of acute care or ambulatory care experience.

Preferred: Over one (1) year of nursing experience in an acute care or ambulatory setting. One (1) + years of pediatric nursing experience and prior experience as Utilization Review nurse.

Education

Required: Graduate of an accredited Licensed Vocational Nursing program.

Preferred: Graduation with a Bachelors Degree in nursing from an accredited University.

Training

Required: None required.

Preferred: Certification in Utilization Review and/or Case Management; CPN.

Specialized Skills

Required: Ability to work effectively under pressure due to changing priorities, interruptions, high/low census, payor demands and discharge planning demands. Excellent interpersonal communication, including conflict resolution, problem solving and negotiation skills. Clinical knowledge of multiple age groups, medical illness, and treatment plans according to disease process, diagnosis, and anticipated LOS. Strong organizational and time management skills, as evidenced by capacity to multi-task and prioritize. Ability to work independently and exercise sound judgment in interactions with physicians, payers, patients, and their families. Demonstrates the knowledge and skills necessary to communicate with third party payers to obtain authorization for the appropriate treatment setting for patients requiring medical, psych, and chemical dependency treatment. Must be proficient in required competencies upon completion of orientation and maintain annual departmental competency requirements. Ability to work collaboratively regardless of social, economic and cultural backgrounds. Computer knowledge to include skills in using Microsoft Office (Excel, Word, Power Point, Access)

Preferred: Knowledge of CCS/Medi-Cal regulations and requirements; Knowledge of third party payor requirements in order to optimize reimbursement; Ability to apply severity of illness/ intensity of service pediatric criteria to information extracted from clinical documentation; Demonstrate knowledge of third party payor methods; bilingual.

Licensure

Required: Licensed Vocational Nurse CA (LVN), Basic Life Support (BLS).

Preferred: Ped Emerg Assess Recog & Stabil (PEARS); Comprehensive Crisis Management (CCM); Certified Pediatric Nurse (CPN).

Work Environments - Functional Demand:

Light - Moderate energy level Lift and carry 25-35 lbs. Push/pull 50-100 lbs. (ie. empty bed, stretcher).

Physical Activity Requirements:

Bending, Carry Objects, Climbing, Keyboard use/repetitive motion, Pinching/fine motor activities, Push/Pull, Reaching forward, Reaching overhead, Sitting, Squat/kneel/crawl (Squad & Knee), Standing, Talk or hear, Taste or smell, Twisting, Walking, Wrist position deviation

Physical Activity Lifting: Lifting (Floor to waist level) - Occasional 0-35%, Lifting (Waist level and above) - Occasional 0-35%

Sensory Requirements: Color Discrimination, Depth Perception, Far Vision, Hearing, Near Vision

Environment Requirements: Airborn Communicable Disease, Bloodborne Pathogens, Chemical, Dust Particular Matter, Extreme Noise Levels, Extreme Temperatures, Radiation, Uneven Surfaces or Elevations

Non-Discrimination Statement:

CHOC does not discriminate on the basis of age, race, color, religion, national origin, ancestry, marital status, genetic information, disability, sex, gender (including pregnancy, breastfeeding, childbirth, lactation or related medical conditions), gender identity or expression, medical condition, sexual orientation, veteran status, military or uniformed service member status, or other protected characteristics in accordance with state and federal laws. CHOC will consider for employment qualified applicants with criminal histories, in accordance with the Fair Chance Initiative for Hiring. We encourage individuals from all backgrounds to apply for positions at CHOC, even if your experience doesn't align perfectly with the listed qualifications for a particular role, as your unique experience may be a great addition to our culture for another one of our opportunities. If you desire support or accommodations throughout the Talent Acquisition process, please inform your Talent Acquisition Partner.