Utilization Review Nurse LVN

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation's leading health systems with nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

Responsible for the daily coordination and oversight to the Referral Technicians with regard to referral distribution and tracking. Assists Director of UR Dept. in providing oversight and monitoring productivity of UR Coordinators and Referral Technicians. Provides training to new staff on system and referral processes. Assists physician offices and vendors with problem resolution. Knowledgeable in policies, procedures and practices and keeps updated with regulations applicable to the department including applicable regulations pertinent to Self-Funded Plan.

Required qualifications:

Possess an active CA Licensed Vocational Nurse (LVN) license.
1. Minimum two years of experience in acute hospital case management or equivalent.
2. Utilization Management experience required.
3. Excellent interpersonal relationship skills with exceptional professional work ethics.
4. Extensive knowledge of professional and hospital claims.
5. Extensive knowledge of coding, billing.
6. High School Diploma or GED

Preferred qualifications:

1. Experience and knowledge of Self-Funded plans, HMO plans, ERISA, and HIPAA guidelines.

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $66,560.00 to $93,600.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.