Utilization Review Coordinator (LVN) - Managed Care
Prime Healthcare, Victorville, CA, United States
Overview
Join an award-winning team of dedicated professionalscommitted to our core values ofquality, compassion and community! Desert Valley Medical Group is affiliated with Desert Valley Hospital, one of the nation’s“100 Top Hospitals”and“A” rated for patient safety. We offer incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.
Desert Valley Hospital, along with Desert Valley Medical Group, offerskey servicesto the community includingheart care, emergency services, labor and delivery, surgical services and more. For more information visit www.DesertValleyHospital.com .
Desert Valley Medical Groupoffers 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
401K retirement plan
Outstanding Medical
Dental
Vision Coverage
Tuition Reimbursement
Many more Voluntary Benefit Options! (https://www.primehealthcare.com/careers/benefits/)
Responsibilities
Coordinates interviews and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Committee Team meetings. Responsible for reviewing patient medical information from medical records and various sources in order to assess, identify, plan, monitor, develop, and coordinate appropriate, cost effective care for all the PMG/IPA capitated members that present significant medical risks/liabilities, in the ambulatory and institutional settings. The scope of the program includes, but is not limited to: acute inpatients/ambulatory i.e. catastrophic cases, chronic cases, transplant/aids cases, institutionalized cases and any member requiring continuity and , ,coordination of care, transition of medical care from one setting to another, behavioral health care, or community resources. Able to work independently and use sound judgment. Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment. Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients and families, Interdisciplinary Care Team and all other committees as appropriate.
Qualifications
EDUCATION, EXPERIENCE, TRAINING
Knowledge of Utilization Management/Case Management terminology and functions, in both Managed Care and Non-Managed Care environments.
At least one year of experience as a Case Manager in an acute care setting or related field and coding chart review for meeting criteria purposes.
Basic to intermediate computer knowledge.
Must have a valid RN/LVN California License.
#LI-TP3
Employment Status
Full Time
Shift
Days
Pay Transparency
Desert Valley Medical Group 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. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $23.37 to $30.29. 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 Status
Full Time
Shift
Days
Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Privacy Notice
Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf
Need help finding the right job?
We can recommend jobs specifically for you!
FacilityDesert Valley Medical Group
LocationUS-CA-Victorville
ID2026-257495
CategoryBusiness Professional
Position TypeFull Time
ShiftDays
Job TypeNon-Exempt
Join an award-winning team of dedicated professionalscommitted to our core values ofquality, compassion and community! Desert Valley Medical Group is affiliated with Desert Valley Hospital, one of the nation’s“100 Top Hospitals”and“A” rated for patient safety. We offer incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.
Desert Valley Hospital, along with Desert Valley Medical Group, offerskey servicesto the community includingheart care, emergency services, labor and delivery, surgical services and more. For more information visit www.DesertValleyHospital.com .
Desert Valley Medical Groupoffers 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
401K retirement plan
Outstanding Medical
Dental
Vision Coverage
Tuition Reimbursement
Many more Voluntary Benefit Options! (https://www.primehealthcare.com/careers/benefits/)
Responsibilities
Coordinates interviews and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Committee Team meetings. Responsible for reviewing patient medical information from medical records and various sources in order to assess, identify, plan, monitor, develop, and coordinate appropriate, cost effective care for all the PMG/IPA capitated members that present significant medical risks/liabilities, in the ambulatory and institutional settings. The scope of the program includes, but is not limited to: acute inpatients/ambulatory i.e. catastrophic cases, chronic cases, transplant/aids cases, institutionalized cases and any member requiring continuity and , ,coordination of care, transition of medical care from one setting to another, behavioral health care, or community resources. Able to work independently and use sound judgment. Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment. Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients and families, Interdisciplinary Care Team and all other committees as appropriate.
Qualifications
EDUCATION, EXPERIENCE, TRAINING
Knowledge of Utilization Management/Case Management terminology and functions, in both Managed Care and Non-Managed Care environments.
At least one year of experience as a Case Manager in an acute care setting or related field and coding chart review for meeting criteria purposes.
Basic to intermediate computer knowledge.
Must have a valid RN/LVN California License.
#LI-TP3
Employment Status
Full Time
Shift
Days
Pay Transparency
Desert Valley Medical Group 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. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $23.37 to $30.29. 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 Status
Full Time
Shift
Days
Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Privacy Notice
Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf
Need help finding the right job?
We can recommend jobs specifically for you!
FacilityDesert Valley Medical Group
LocationUS-CA-Victorville
ID2026-257495
CategoryBusiness Professional
Position TypeFull Time
ShiftDays
Job TypeNon-Exempt