Utilization Review LVN

14 hours ago


Corona, California, United States KPC GLOBAL MEDICAL CENTERS INC Full time
Job SummaryAs a Utilization Review LVN at KPC GLOBAL MEDICAL CENTERS INC, you will play a critical role in ensuring the efficient and effective delivery of healthcare services. Key Responsibilities
  • Coordinate and review medical records for assigned caseloads, ensuring compliance with Federal, State, and intermediary guidelines.
  • Participate in Case Management and Treatment Team meetings, contributing to the development of comprehensive care plans.
  • Provide education and training to healthcare staff on utilization review and case management best practices.
  • Assess patient charts to determine adherence to treatment plans and identify areas for improvement.
  • Communicate with fiscal intermediaries, patients, and families to facilitate discharge referrals and ensure continuity of care.
  • Perform other duties as assigned by management.
Requirements
  • Knowledge of Federal, State, and intermediary guidelines related to inpatient and outpatient care.
  • Ability to work independently and use sound judgment in decision-making.
  • Strong communication and interpersonal skills.
  • Ability to analyze complex data and develop effective solutions.


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