Utilization Review LVN - Dignity Health : Job Details

The Utilization Review LVN uses clinical judgement in providing utilization management services. The focus is to provide high quality, cost-effective care which will enable patients to achieve maximum medical improvement while receiving care deemed medically necessary. The LVN assists in determining appropriateness, quality and medical necessity of referral requests using pre-established guidelines. This position supports Woodland Clinic Medical Group in effective management of the managed care patient. This position may be assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review. Responsibilties may include:- Determines correct type of referral and utilizes correct criteria in performing review and documents appropriate sections.- Preps case thoroughly, concisely and clearly for physician review. Researches EMR, criteria, medical policy and past history of member to detail case cleanly for MD.- Communicates findings to physician and member ...LVN, Clinical, Medical, Health, Healthcare, Physician