- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …leadership, teamwork, and communication skills. ESSENTIAL DUTIES The primary responsibility of the Utilization Review Specialist is to review medical records ... of candidates. Education Associates Degree preferred Minimum Work Experience Utilization Review experience preferably in a behavioral/psychiatric healthcare… more
- Tenet Healthcare (Detroit, MI)
- …impact of care options May, if licensed RN, oversee work delegated to Utilization Review LVN /LPN and/or Authorization Coordinator. (10% daily, essential) ... Group Utilization Review Director - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients… more
- UCLA Health (Los Angeles, CA)
- …with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, or health plan ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more
- The Arora Group (Bethesda, MD)
- …- Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/ LVN ) - Utilization Review in Bethesda, Maryland to provide care to ... be required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/ LVN ) - UTILIZATION REVIEW : + Initiate, perform and complete assigned duties in… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity… more
- Prime Healthcare (Chino, CA)
- …for its quality, including as among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. ... EDUCATION, EXPERIENCE, TRAINING Required qualifications. 1. Knowledge in discharge planning/ utilization management/case management terminology and functions, in both managed… more
- Veterans Affairs, Veterans Health Administration (Ukiah, CA)
- …Coordinator for questions/assistance. Learn more Duties and responsibilities of the LVN /LPN include: Incumbent performs retrospective medical review of non-VA ... Summary The Licensed Vocational Nurse/Practical Nurse ( LVN /LPN) have a broad degree of practical nursing...the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... (AHA BLS Healthcare) - American Heart Association; California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric Technicians; Vocational… more
- STG International (Milledgeville, GA)
- …our Georgia War Veterans Home. JOB SUMMARY: The primary purpose of the lead LPN/ LVN is to provide direct nursing care to the residents. ESSENTIAL FUNCTIONS: + Ensure ... forms, reports, evaluations, studies, charting, etc., as necessary. + Periodically review the department's policies and procedures manuals, job descriptions, etc.,… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... Product Certification) - Various-Employee provides certificate; California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric Technicians… more
- UCLA Health (Los Angeles, CA)
- …patient records + Familiarity with the laws, rules, and regulations regarding utilization review and discharge planning of government programs such Medicare, ... care plans + Utilize evidence-based tools for risk stratification + Perform utilization reviews, including authorization reviews + Ensure delivery of concurrent and… more
- Prime Healthcare (Chino, CA)
- …for its quality, including as among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. ... EXPERIENCE, TRAINING Required qualifications 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and functions, in both… more
- Molina Healthcare (Las Cruces, NM)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse ( LVN ) or Licensed Practical Nurse (LPN) Program OR a bachelor's or master's… more
- Molina Healthcare (Dayton, OH)
- …in good standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... Any of the following: Completion of an accredited Licensed Vocational Nurse ( LVN ) or Licensed Practical Nurse (LPN) Program **Required Experience** 1-3 years of… more
- Centene Corporation (Sacramento, CA)
- …applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA ... of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical… more
- Tenet Healthcare (Detroit, MI)
- …to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patients resources and right to ... national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition Management… more
- Veterans Affairs, Veterans Health Administration (Eureka, CA)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... will be considered as vacancies become available.** Duties and responsibilities of the LVN /LPN include: Serves as a role model and mentor to other nursing staff… more
- ManpowerGroup (Columbia, SC)
- …communicate with members and healthcare providers. **Key Responsibilities** ✔ **Medical Review & Utilization Management (80%)** + Perform medical reviews ... + Review interdepartmental requests for medical information to support utilization processes. + Conduct high-dollar forecasting and patient health summaries. +… more
- ChenMed (St. Louis, MO)
- … and discharge planning. **KNOWLEDGE, SKILLS AND ABILITIES:** + Knowledge of Utilization Review (UR) and discharge planning + Strong interpersonal and ... ACN role may be performed by an RN or LPN/ LVN with each performing within their state specific licensure...experience required + A minimum of 1 year of utilization review and/or case management, home health,… more
- Banner Health (Greeley, CO)
- …management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission process ... MINIMUM QUALIFICATIONS Must possess a current, valid LPN or LVN license in state of practice, temporary LPN or... license in state of practice, temporary LPN or LVN license in state of practice, or compact LPN… more
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