CONCURRENT REVIEW LVN - UTILIZATION MANAGEMENT - JOB POSITION #2019-187
- Date Posted:
- Close Date:
- Full Time
- Redlands Monday - Friday 8:00a.m. - 5:00p.m.
general direction of the Director of UM, UM Administrative Manager, and UM
Nurse Supervisor/Educator, the Concurrent Review LVN performs concurrent or
retrospective review of acute in-patient and skilled nursing facility services,
as required, using established criteria to meet the contractual and regulatory
requirements while acting within the scope of the Board of Vocational Nursing
and Psychiatric Technicians of the State of California. The Concurrent Review
LVN will promote the quality and cost effectiveness of medical care provided to
patients by applying appropriate nationally recognized guidelines, criteria,
and evidence based standards. Also assists UM management and Compliance team in
preparation for audits and other regulatory activities as needed.
High School or
equivalent. Graduation from an
accredited LVN school of nursing, or have completed coursework allowing
candidate to challenge the VN Board of Nursing and attain LVN designation.
Current State of California LVN licensure. Two years clinical experience in an
acute or ambulatory patient care setting including one year in a managed care
environment such as a medical group, independent physician association, or
health plan is required. Strong clinical nursing background. Knowledge of
Medicare, DMHC, NCQA, and MCG Guidelines. Understanding of concepts and
principles of managed care.