Title: LVN Case Manager
Location: Fountain Valley
Department: Utilization Management
Status: Full-time
Shift: Day
Pay Range*: $32.81/hour - $47.57/hour
MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.
Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.
Position Summary
- Under supervision of Director of Medical Management provides utilization review and management for SHP members while at the same time coordinating quality of care, in a timely and cost-effective manner.
- Consistently provides decision making, complies with turnaround time frames, follows UM criteria to ensure processing of request for referral authorizations will not interfere with or cause delay in service, or preclude delivery of services.
- This position is responsible for implementing and coordinating all utilization management functions relating to pre-certification of outpatient services. The LVN Case Manager in this capacity is responsible for coordinating authorizations and notifications.
- Provides workflow, direction, organization and monitoring of authorizations/utilization management. Coordinates and tracks authorization files between Authorization Coordinators and Physician reviewer.
- Updates SHP systems to reflect current and ongoing authorization status.
Essential Functions and Responsibilities of the Job
- Clear understanding of managed healthcare, utilization management.
- Possess knowledge of applicable regulatory standards and is able to prepare for audits based upon these standards.
- Ability to maintain compliance and turnaround time standards for all UM assignments.
- Provide excellent customer service to our members.
- Communicate effectively with a professional attitude.
- Be responsible and accountable for all assignments and deliverables.
- Follow company policies, procedures and directives.
- Interact in a positive and constructive manner.
- Prioritize and multitask in a fast-paced work environment.
*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more... Check out our MemorialCare Benefits for more information about our Benefits and Rewards.
Minimum Requirements
Qualifications/Work Experience:
- 1-2 years acute care background preferred.
- 1-year managed healthcare; health plan experience helpful.
- Prior experience in UM preferred.
- Medical terminology proficient.
- Knowledge of ICD9-10.
- Knowledge of CPT codes.
Education/Licensure/Certification:
- Graduated from an accredited school of nursing.
- Must hold a current California unrestricted LVN license.
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