St Francis Medical Center

Utilization Review Nurse LVN

St Francis Medical Center$71K — $99K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Active CA Licensed Vocational Nurse (LVN) license required
  • Minimum 2 years of experience in acute hospital case management or similar role
  • Required experience in Utilization Management
  • Strong interpersonal skills with excellent professional ethics
  • Deep knowledge of professional and hospital claims
  • Proficient in coding and billing
  • High School Diploma or GED required

Responsibilities

  • Oversee daily operations and referral distribution for Referral Technicians
  • Assist the Director of UR Department in monitoring productivity of staff
  • Provide training to new team members on referral processes and systems
  • Resolve issues for physician offices and vendors
  • Stay updated on department regulations and policies affecting Self-Funded Plans

Benefits

  • Flexible benefits package allowing tailored options to employee needs
  • Includes paid time off and a 401K retirement plan
  • Medical, dental, and vision coverage offered
  • Tuition reimbursement available
  • Variety of additional voluntary benefit options
Full Job Description
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:

  • Possess an active CA Licensed Vocational Nurse (LVN) license.
  • Minimum (2) two years of experience in acute hospital case management or equivalent.
  • Utilization Management experience required.
  • Excellent interpersonal relationship skills with exceptional professional work ethics.
  • Extensive knowledge of professional and hospital claims.
  • Extensive knowledge of coding, billing.
  • High School Diploma or GED
  • Preferred qualifications:

  • 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 StatusFull Time ShiftDays

    About St Francis Medical Center

    St. Francis Medical Center is a for-profit hospital in Lynwood, California, United States, owned by Prime Healthcare Services.
    Learn more about St Francis Medical Center

    Similar Jobs

    More Jobs at St Francis Medical Center

    More Healthcare Jobs

    • Speech Language Pathologist School
      Confidential Company
      Houston, TX 77002 (Harris County)
    • LNHA – Business Development Sales
      $110K — $130K *
      American Physiatry
      Orlando, FL 32801 (Orange County)
    • Controller
      $80K — $150K + bonus additional *
      The Vernon Staffing Group
      Paris, TX 75460 (Lamar County)
    • Center-Based BCBA
      $85K — $110K *
      Proud Moments
      Bridgeton, NJ 08302 (Cumberland County)
    • BCBA
      $187K — $208K *
      Proud Moments
      Queens Village, NY 11429 (Queens County)

    Find similar Utilization Review Nurse LVN jobs: