Concurrent Review LVN - Utilization Management - Job Position #2019-187

CONCURRENT REVIEW LVN - UTILIZATION MANAGEMENT - JOB POSITION #2019-187

Date Posted:
Close Date:
2019-05-21
Classification:
Administrative
Type
Full Time
Location
Redlands Monday - Friday 8:00a.m. - 5:00p.m.

Job Description

Under the 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.

Qualifications

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.

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