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Utilization Review Nurse LVN

Prime Healthcare Ontario, CA Full-Time
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Prime Healthcare is an award-winning health system operating 45 hospitals in 14 states. It is one of the nation's leading healthcare service providers with more than 43,500 employees and physicians dedicated to providing the highest quality healthcare. We believe that "all healthcare is local." Explore a hospital in your community.


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.


*Please note: position is full-time and possibility for remote/ shared time between Corporate Office in Ontario and near-by Prime Hospital.*




Required qualifications:

1. Possess an active CA Licensed Vocational Nurse (LVN) license

2. Minimum (2) two years’ experience in acute hospital case management or equivalent3. Utilization Management experience required4. Excellent interpersonal relationship skills with exceptional professional work ethics5. Extensive knowledge of professional and hospital claims6. Extensive knowledge of coding, billing7. High School Diploma or GED


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

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.  EEO is the Law: [ Link removed ] - Click here to apply to Utilization Review Nurse LVN />

Recommended skills

Case Management
Utilization Management
Licensed Vocational Nurses
Health Insurance Portability And Accountability Act (Hipaa) Compliance
Distribution (Business)
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Job ID: 2019-37640


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