RN - LEAD CARE COORDINATOR - Utilization Review Specialist
1 week ago
As a Lead Care Coordinator RN, you will play a critical role in guiding and managing Utilization Review and Management for the Loyola Physician Partners Health Plan. This position is located at the Westmont office and offers a unique opportunity to work in an organization that focuses on treating the whole person, physically, emotionally, and spiritually.
Key Responsibilities:
• Evaluate medical necessity of preauthorization requests utilizing defined criteria.
• Collect, analyze, and communicate relevant utilization management information to insurers and third-party payers.
• Develop, implement, and monitor administrative and clinical processes to ensure staff activities are focused on achieving the LPP program goals.
• Provide feedback to staff on performance, including identifying performance improvement opportunities and working collaboratively with staff to develop and implement remediation plans.
Requirements:
• Bachelor's Degree in Nursing or related field.
• Master's Degree or equivalent training acquired via work experience or education.
• Experience with mcg or Interqual and Epic EMR highly desired.
• Experience with inpatient UR and/or outpatient referral authorizations highly desired.
What We Offer:
• Tuition Reimbursement.
• Opportunity to work in a dynamic and supportive team environment.
• Commitment to diversity, equity, and inclusion.
• Equal Opportunity Employer.
About Trinity Health:
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. We integrate diversity, equity, and inclusion in all that we do, providing the most accessible and equitable care for those we serve.
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