UM Registered Nurse

Description Job Description
POSITION: UM REGISTERED NURSE (RN)
UM LICENSED VOCATIONAL NURSE (LVN)
Department: Utilization Management
Reports to: UM Manager

Position Summary:
This position provides RN level review of referral requests received in the Utilization Management Department.

Job Duties and Essential Functions:
• Read and be familiar with the Employee Handbook and obey all rules
• Be timely and prompt in attendance, as this position requires presence at the
opening of business until close.
• As a nurse reviewer
• The Registered Nurse (RN) / Licensed Vocational Nurse (LVN) is primarily
responsible for nurse level day-to-day medical decisions.
• He or she has frequent interactions with UM coordinators and network providers,
the Medical Director, doctors and reviewing doctors as well as representatives of
health plans.
• As a supervisor:
• Assign work to UM coordinators
• Collect all TARs at the end of the day to tally the production
• To answer phone calls
• To conduct an in-office UM meeting
• To provide orientation to all UM coordinators
• Check all work performed by coordinators
• Communicate with providers and/or their employees
• Communicate with health plan representative
UM Nurse 09 06 25.wpd
• Check members’ benefits
• Check CPT / ICD codes
• Check hospital assignments

Physical Requirements:
• Ability to sit for lengthy periods
• Extensive telephone usage
• Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts, or correctable with reasonable measures to that range
• Viewing a computer monitor for lengthy periods
• Light walking and standing duties

Educational Requirements:
• State of California RN / LVN license is required
• Current unrestricted license in good standing
• Good clinical knowledge
• Basic knowledge of Managed care operations

Experience/Skills:
• Computer literate
• MS Word, MS Excel expertise required
• Computer knowledge
• Typing skill 35-45 word per minutes
• 10 key proficiency
• E-Z Cap software knowledge required, or familiarization during training
• Minimum 2 yrs UM experience
• Willing to learn

Requirements Educational Requirements:
• State of California RN / LVN license is required
• Current unrestricted license in good standing
• Good clinical knowledge
• Basic knowledge of Managed care operations

Physical Requirements:
• Ability to sit for lengthy periods
• Extensive telephone usage
• Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts, or correctable with reasonable measures to that range
• Viewing a computer monitor for lengthy periods
• Light walking and standing duties