Utilization Review Nurse LVN

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states, providing over 2.5 million patient visits annually. It is one of the nation’s leading health systems with nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Company is an equal employment opportunity employer. We prohibit discrimination and harassment based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to law), disability, military status, genetic information, or any other protected category. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

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

Responsibilities

The role involves daily coordination and oversight of Referral Technicians regarding referral distribution and tracking. Assists the Director of UR Department in monitoring the productivity of UR Coordinators and Referral Technicians. Provides training to new staff on systems and referral processes. Supports physician offices and vendors with problem resolution. Must be knowledgeable about policies, procedures, and regulations relevant to the department, including those pertaining to Self-Funded Plans.

Qualifications

Required qualifications:

• Active CA Licensed Vocational Nurse (LVN) license.
• Minimum two years of experience in acute hospital case management or equivalent.
• Utilization Management experience required.
• Excellent interpersonal skills and professional ethics.
• Extensive knowledge of professional and hospital claims, coding, and billing.
• High School Diploma or GED.

Preferred qualifications:

• Experience with Self-Funded plans, HMO plans, ERISA, and HIPAA guidelines.

Prime Healthcare offers a competitive benefits package, including paid time off, 401K, medical, dental, and vision coverage, tuition reimbursement, and voluntary benefits. Compensation ranges from $66,560 to $93,600 annually, depending on experience and qualifications. The exact offer will be determined at hire.