LVN Utilization Manager

4 weeks ago

Van Nuys, California, United States Clinica Romero Full time
Job Summary

Clinica Romero is seeking a skilled LVN Utilization Manager to join our team. As a key member of our healthcare team, you will play a vital role in ensuring the efficient and effective delivery of healthcare services.

Job Responsibilities
  • Conduct concurrent reviews of patient clinical information to ensure quality and cost efficiency.
  • Review precertification requests for medical necessity and ensure compliance with guidelines.
  • Monitor the activities of clinical and non-clinical staff to ensure adherence to protocols.
  • Coordinate patient discharge planning needs with the healthcare team.
  • Maintain accurate records of patient interactions and prepare monthly reports.
  • Perform utilization review activities, including precertification and retrospective reviews.
  • Determine medical necessity of requests using approved evidence-based guidelines.
  • Answer utilization management directed telephone calls and manage them professionally.
  • Refer cases to reviewing physicians when treatment requests do not meet necessity or guidelines are not available.
  • Conduct and document rate negotiations with out-of-network providers.
  • Identify and refer potential cases to appropriate departments for follow-up.
  • Collaborate with leadership and management to improve work processes.
  • Monitor supplies and coordinate with the Office Manager for procurement of medical and office supplies.
  • Provide therapeutic patient care within scope of practice and in accordance with the plan of care.
  • Enhance patient visits with providers by providing ongoing education on treatments, disease processes, and health maintenance.
  • Provide patient group educational opportunities on various topics.
  • Administer medications and treatments as ordered by providers.
  • Facilitate the efficient flow of the walk-in process by monitoring patient conditions and identifying unexpected findings.
  • Initiate emergency procedures and communicate with providers/MD.
  • Report unusual occurrences to the MD in a timely fashion.
  • Ensure cleanliness of nursing areas and patient rooms.
  • Promote and improve customer service to patients and staff.
Requirements
  • Vocational Nurse license.
  • Minimum one year supervisory experience in a medical office, clinic, or healthcare 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 multiple 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.
  • Current CPR certification.
  • Strong clerical/administrative skills including computer skills.
  • Current California driver's license and legally required automobile insurance.

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