Pediatric Utilization Review LVN

Children’s Hospital of Orange County; United States; On-site; USD 61,000 - 101,000; Full time

Job summary

CHOC, the Children’s Hospital of Orange County, is seeking a Utilization Review Representative in Orange, CA. You will perform utilization reviews for inpatients and outpatients and handle authorization requests with payors in collaboration with RN Care Managers.

The role requires nursing experience in acute or ambulatory settings, LVN licensure in CA, and relevant certifications. Strong communication and organizational skills are essential, with a focus on accuracy and patient advocacy.

Qualifications

• Licensed Vocational Nurse (CA) license required.
• Nursing experience in acute or ambulatory care preferred.
• Certifications in Utilization Review and/or Case Management; CPN preferred.

Responsibilities

• Perform utilization review for all inpatient and outpatient statuses.
• Process internal and external authorization requests with payors for treatments, services and supplies.
• Assist RN Care Manager with case load and data collection.
• Verify insurance and provide financial counseling and customer service.
• Ensure accuracy and completeness of work across responsibilities.

Skills

Communication

Conflict resolution

Problem solving

Negotiation

Time management

Multi-tasking

Independent judgment

Teamwork

Education

Licensed Vocational Nurse CA

BLS Certification

Tools

Microsoft Office

Job description

CHOC, the Children’s Hospital of Orange County, is seeking a Utilization Review Representative in Orange, CA. You will perform utilization reviews for inpatients and outpatients and handle authorization requests with payors in collaboration with RN Care Managers.

The role requires nursing experience in acute or ambulatory settings, LVN licensure in CA, and relevant certifications. Strong communication and organizational skills are essential, with a focus on accuracy and patient advocacy.