[Hiring] SRS – LVN Utilization Management @Sharp HealthCare

Role Description

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.

Qualifications

• California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians - REQUIRED
• 3 Years experience as an LVN in a hospital or clinical setting (Preferred)
• 2 Years utilization/Case Management experience, preferably in a Managed Care setting (Preferred)
• Experience as a case manager or discharge planner interacting with managed care payers (Preferred)
• California Licensed Vocational Nurse (LVN) - License must be unrestricted (Other Qualification Requirements)

Requirements

• Ensure consistent application of the utilization review process for effective utilization of resources.
• Identify when services are not medically necessary and/or not covered benefits and refer to Utilization Review Committee.
• 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.
• Demonstrate knowledge of Health Plan contracts and Health Plan benefits.
• Coordinate services and supplies through SRS (or health plan) contracted vendors.
• Collaborate with referring physicians, providers, or vendors.
• Advocate for both client and payer.
• Identify cost-effective, appropriate alternatives.
• Ensure high volume of referrals are processed accurately in a timely manner.
• Maintain knowledge and understanding of applicable accreditation and regulatory statutes.
• Identify opportunities for intervention which may include identification of patterns/trends.
• Communicate opportunities to Leadership.
• Engage problem-solving skills to reconcile differing points of view.
• Promote effective communication among healthcare team members, the payer, and other relevant parties.

Benefits

• Hourly Pay Range (Minimum - Midpoint - Maximum): $34.170 - $44.090 - $49.370
• The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.
• The actual pay rate and pay grade will depend on various factors, including experience, skills, education, and marketplace factors.

Company Description

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, or status as a qualified individual with a disability or any other protected class.