Utilization Review LVN

3 weeks ago


Corona, United States KPC GLOBAL MEDICAL CENTERS INC Full time
Job DescriptionJob Description
  • Coordinates and reviews all medical records, as assigned to caseload
  • Actively participates in Case Management and Treatment Team meetings
  • Serves as on-going educator to all departments
  • Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from fiscal intermediary; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting
  • Able to work independently and use sound judgment.
  • Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.
  • Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.
  • Performs other duties as assigned.


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