Licensed Vocational Nurse (LVN) - Utilization Review

Tenet Healthcare; San Antonio (TX); On-site; USD 85,000 - 105,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) with employer match

Generous paid time off

Career development opportunities

Health savings accounts

Job summary

Baptist Health System Hospital, part of Tenet Healthcare, is seeking a skilled case management professional to coordinate utilization management and ensure medically necessary care within policy. The role emphasizes collaboration with payers, physicians, and hospital staff to optimize patient care and resource use.

The position involves medical necessity screening, payer authorizations, documentation, and continuous quality improvements, with potential sign-on bonus in this dynamic healthcare

Qualifications

• Graduate of an accredited School of Nursing.
• Active LVN/LPN license for state(s) covered.
• Minimum 2 years acute hospital or behavioral health patient care experience.
• 1 year utilization review in an acute hospital or commercial/managed care payer setting.
• ACM certification is preferred.

Responsibilities

• Accurate medical necessity screening and submission for Physician Advisor review.
• Secure and document authorization for services from payers.
• Manage concurrent disputes and coordinate with payers, physicians, office staff and ancillary departments.
• Ensure timely, complete and concise documentation in the Tenet Case Management system.
• Maintain accurate patient demographic and insurance information; identify potentially avoidable days and reporting of utilization patterns.

Education

Graduate of an accredited School of Nursing

Associates in Nursing

Job description

Overview

Baptist Health System Hospital is committed to providing exceptional patient care in a supportive and collaborative environment. As a member of our team, you will have the opportunity to work with advanced technology and be part of a healthcare community dedicated to making a positive impact on the lives of our patients.

At Baptist Health System, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status

Job Summary

This position may qualify for a sign-on bonus The individual in this position is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position integrates national standards for case management scope of services including:

• Utilization Management services supporting medical necessity and denial prevention
• Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient
• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
• Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits

The individual’s responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review, b) securing and documenting authorization for services from payers, c) managing concurrent disputes, d) collaborating with payers, physicians, office staff and ancillary departments, e) timely, complete and concise documentation in the Tenet Case Management documentation system, f) maintenance of accurate patient demographic and insurance information, g) identification and documentation of potentially avoidable days, h) identification and reporting over and underutilization, i) and other duties as assigned

Qualifications

MINIMUM EDUCATION: Graduate of an accredited School of Nursing

PREFERRED EDUCATION: Associates in Nursing

MINIMUM EXPERIENCE: 2 years acute hospital or behavioral health patient care experience with at least

1 year utilization review in an acute hospital or commercial/managed care payer setting.

PREFERRED EXPERIENCE: 1 year hospital acute or behavioral health case management experience.

REQUIRED CERTIFICATIONS/LICENSURE: Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active LVN/LPN license for state(s) covered.

PREFERRED CERTIFICATIONS/LICENSURE: Accredited Case Management (ACM)

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Organization Description

Baptist Health System has more than 120 years history of caring for our community and making a positive difference. Our system of care includes six full-service hospitals, a specialized childrens hospital with a dedicated pediatric emergency unit, a comprehensive cancer care network, fitness and rehabilitation centers, a physician network, imaging centers, ambulatory services and the Baptist School of Health Professions. Wherever you go in the Baptist Health System, youll find that we have the same goal to help people achieve health for life through compassionate service inspired by faith. Join our team!

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: http://www.uscis.gov/e-verify The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.