- Dignity Health (Rancho Cordova, CA)
- …is work from home within the Greater Sacramento, CA region.** **Position Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing ... outcomes of patients. **Job Requirements** **Minimum Qualifications:** - 3 years Managed Care/ Utilization Management (UM) experience. - 5 years LVN experience. -… 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
- Molina Healthcare (Dayton, OH)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Long Beach, CA)
- …**Required Experience** Minimum three years clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required ... implementation of proactive approaches to improve and standardize overall retrospective claims review . * Ensures core system is updated correctly to process claim..… more
- STG International (Milledgeville, GA)
- STGi is seeking a LPN/ LVN to provide services at our Georgia War Veterans Home. If you have compassion and a passion to care for Veterans, this could be the job for ... you! JOB SUMMARY: The primary purpose of the lead LPN/ LVN is to provide direct nursing care to the residents. ESSENTIAL FUNCTIONS: + Ensure the facility meets the… more
- Banner Health (Susanville, CA)
- …management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission process ... general surgeries and orthopedics. **As a Licensed Vocational Nurse, LVN , at Banner Lassen Health Center, you will perform...assessments, prepping patients for the provider and more. This LVN is a full time Monday - Friday with… 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 ... Start Time** **Shift End Time** California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric...Follows policy and procedure for entering of OCM and utilization of IDX. Completes work within assigned hours.Able to… more
- Dignity Health (Bakersfield, CA)
- …as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the ... of defined levels of hierarchy and composition of compliant denial notices to review medical records, authorize requested services and prepare cases for physician … more
- Sharp HealthCare (Chula Vista, 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 **Hours**… more
- Pomona Valley Hospital Medical Center (Pomona, CA)
- …education necessary to meet licensure requirements. One year experience in Utilization Review or Case Management discharge planning, current knowledge/use ... plays a vital role within the Case Management Department. The LVN within the Utilization Management team collaborates closely with Case Managers, support staff,… more
- ERP International (Camp Lejeune, NC)
- …providers for 90% of all referrals. + Provides timely, descriptive feedback regarding utilization review issues. + Reviews and enters first right of refusal ... ERP International is seeking full-time **Licensed Practical** **/Vocational Nurses (LPN/ LVN )** in support of Referral Management Center at theNaval Medical… more
- UnityPoint Health (Cedar Rapids, IA)
- …+ Is knowledgeable regarding managed care implications - precertifications and utilization review + Maintains competence in performing procedures involved ... with the management of violent or potentially violent patients. Complies with policies for restraint and seclusion per service guidelines. Qualifications + Current licensure in good standing to practice as a licensed practical nurse in the state of Iowa. +… more
- STG International (Temple, TX)
- …not on the formulary 4. Comply with all VA reporting per VLB timelines 5. Review RX policy and procedures annually 6. Represent community with agencies as needed 7. ... balancing cost to care in pharmacy ordering, alternative substitutions and off formulary utilization . 25. Participates as a team member in the results of Survey… more
- Molina Healthcare (GA)
- …performance of one or more of the following activities: care review , care management, utilization management (prior authorizations, inpatient/outpatient medical ... in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS),… more
- Molina Healthcare (GA)
- …services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team ... of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral… more
- Molina Healthcare (Albuquerque, NM)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a compact license who resides in New Mexico or Texas. This team ... 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 (Layton, UT)
- …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
- 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 (Amarillo, TX)
- …by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities VA Careers - Licensed Practical Nurse: ... The primary purpose of the Licensed Practical/License Vocational Nurse (LPN/ LVN ) is to perform assigned duties in a manner...understanding of the long sheet and importance of daily utilization of the form; Working knowledge of shower/tub room… more
- CVS Health (MI)
- …advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and ... compliance driven timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization and… more