UTILIZATION REVIEW LVN

Job ID
2020-142640
Employment Type
Full Time
Department
Utilization Review
Hours / Pay Period
80
Facility
Dignity Health Management Services Organization
Shift
Day
Standard Hours
Mon-Fri (8-5 PM)
Work Schedule
8 Hour
Location
CA-Bakersfield

Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

 

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

Responsibilities

The utilization review LVN uses clinical judgement in providing utilization management services. The focus is to provide high quality, cost-effective care which will enable patients to achieve maximum medical improvement while receiving care deemed medically necessary.

Qualifications


    Minimum


  • Strong organization skills.


  • Effective telephone and computer data entry skills required.


  • Ability to formulate ideas and solutions into appropriate questions and assess/interpret the verbal responses.


  • Ability to communicate effectively with coworkers, members, their families, physicians and health care providers.


  • Minimum 3 years UM experience.


  • 5 years' clinical experience as a RN/LVN in acute, ambulatory care, home health or SNF.


  • CPR , LVN



  • Preferred


  • Knowledge of California health plans and differences between commercial and advantage plans.


  • Familiarity with business practices and protocols with ability to access data and information using automated systems.


  • General knowledge of UM and Managed Care.


  • Use of InterQual guidelines.


  • Experience at meeting deadlines by prioritizing work flow.


  • Physician group experience preferred.



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