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LVN Utilization Manager

companyClinica Romero
locationLos Angeles, CA, USA
PublishedPublished: 6/14/2022
Full Time

Job Description

Salary: $66,560 - $80,000

Position Title:                           LVN Utilization Manager

Department:                               Medical

Position reports to:                  Director of Nursing

Position Summary:­­
The LVN Utilization Manager ensures that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment.

Responsibilities:

  • Concurrent review of patient’s clinical information for efficiency
  • Ongoing review of precertification requests for medical necessity
  • Monitor the activities of clinical and non-clinical staff
  • Coordinates patient’s discharge planning needs with the healthcare team
  • Maintain accurate records of all patient related interactions
  • Prepare monthly patient management and cost savings report
  • Performed utilization review activities, including precertification, and retrospective reviews according to guidelines.
  • Determined the medical necessity of requests by performing first level reviews using approved evidence       based guidelines/criteria.
  • Answered Utilization Management directed telephone calls; managing them in a professional and competent way.
  • Referred cases to reviewing physician when the treatment request did not meet necessity per guidelines, or when guidelines were not available.
  • Conducted and documented rate negotiations with out of network providers, utilizing appropriate reimbursement methodologies.
  • Identify and refer potential cases to appropriate department for follow up
  • Consistently demonstrating excellence in quality assurance evaluations of work production.
  • Taking initiative to work as a team with other medical staff in meeting production goals.
  • Collaborating with leadership and management in improvement measures for work processes.
  • Monitors supplies and coordinates with the Office Manager for the procurement of medical, office supplies and equipment to ensure the availability of adequate equipment and supplies required to provide patient care services
  • Provides therapeutic patient care within scope of practice in accordance with the plan of care developed by the patient and provider 
  • Enhances patient visits with provider by providing ongoing education to patients regarding treatments, disease processes, health maintenance and medication adherence
  • Provides regularly scheduled patient group educational opportunities on various topics to be conducted in general meeting areas (i.e. including patient waiting room)
  • Gives oral, intradermal, subcutaneous, intramuscular, topical medications, and treatments as ordered by provider
  • Facilitates the efficient flow of the walk-in process by, within scope of practice, monitoring patient’s condition by observing signs, symptoms and reactions to treatments/therapies to identify unexpected and/or significant findings as needed
  • Initiates appropriate emergency procedure and communicates with the providers/MD
  • Reports to the MD any unusual occurrences in a timely fashion
  • Ensures cleanliness of nursing area, patient room and proper functioning of equipment by visual inspection, routine testing and other methods
  • Promotes, ensures and improves customer service to patients and staff by demonstrating skills which are consistent with the organization’s values

Qualifications/Requirements:

  • License Vocational Nurse
  • Experience and education – Minimum one year supervisory experience in a medical office, clinic, or other health care facility.  High school graduate or GED equivalent; BA/BS or equivalent experience; completion of Board of Vocational Nursing
  • Cultural and linguistic competency and diversity sensitivity
  • Ability to manage priorities, workflow, and multiples tasks in an ever-changing environment
  • Versatility, flexibility, willingness, and enthusiasm in a rapid pace environment
  • Attention to detail
  • Ability to work independently and as a member of various teams and committees
  • Strong interpersonal and communication skills
  • Ability to understand and adhere to established policies, procedures, and protocols
  • Strong charting/documentation skills
  • Bilingual (English/Spanish) strongly recommended
  • Must possess current CPR certification
  • Strong clerical/administrative skills including computer skills
  • Current California driver’s license and legally required automobile insurance
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