Utilization Review Nurse LVN Job at Prime Healthcare Management Inc, Ontario, CA

alUyeHBKTHRoTkM0SHNZeEJJZUlITVR0
  • Prime Healthcare Management Inc
  • Ontario, CA

Job Description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation’s leading health systems with nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights:

Privacy Notice for California Applicants:

Responsibilities

Responsible for the daily coordination and oversight to the Referral Technicians with regard to referral distribution and tracking. Assists Director of UR Dept. in providing oversight and monitoring productivity of UR Coordinators and Referral Technicians. Provides training to new staff on system and referral processes. Assists physician offices and vendors with problem resolution. Knowledgeable in policies, procedures and practices and keeps updated with regulations applicable to the department including applicable regulations pertinent to Self-Funded Plan.

Qualifications

Required qualifications:

  1. Possess an active CA Licensed Vocational Nurse (LVN) license.
  2. Minimum two years of experience in acute hospital case management or equivalent.
  3. Utilization Management experience required.
  4. Excellent interpersonal relationship skills with exceptional professional work ethics.
  5. Extensive knowledge of professional and hospital claims.
  6. Extensive knowledge of coding, billing.
  7. High School Diploma or GED

Preferred qualifications:

  1. Experience and knowledge of Self-Funded plans, HMO plans, ERISA, and HIPAA guidelines.

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.  Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary.  A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $66,560.00 to $93,600.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Job Tags

Full time, Temporary work, Part time, Local area,

Similar Jobs

Abernathy Home Care

Per Diem Home Care Nurse (RN/LPN) Job at Abernathy Home Care

 ...Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) to join our per diem team.Position Summary:As a per diem home care nurse, you will...  ...Requirements: * At least 18 years of age* Current MA RN or LPN license in good standing * A drivers license in good... 

FACCES Careers

Chef/Cook Job at FACCES Careers

 ...Chef/Cook Schedule will be anywhere from 25-35 hours a week, and must be ok working with children We are a premier school located in Columbus, Ohio, with a nationally accredited program for children. FACCES at Starting Point has a state-of-the-art kitchen, and... 

PDS Defense

FAA Assembly and Test Technician Job at PDS Defense

**Light Industrial/Manufacturing****FAA Assembly and Test Technician** Torrance, CA Posted: 5/22/2025Job DescriptionJob ID#:211507Job Category:Light Industrial/ManufacturingPosition Type:Associate - W2Shift:2**PDS Defense, Inc. is seeking an FAA Assembly and... 

The Eye Group

Optometrist job - Drayton Valley, Alberta Canada - OD opportunity Job at The Eye Group

 ...guarantee salary and performance-based bonuses. Can be full time or part time, ODs choice. Utilizing the latest technological innovations...  ...Cater to family members of all ages, from young children to senior citizens. Join established practice with a loyal customer base,... 

State of Florida

PUBLIC DEFENDER'S OFFICE, 8TH CIRCUIT- ASSISTANT PUBLIC DEFENDER - 21004057 Job at State of Florida

 ...Requisition No:852428 Agency: Justice Administrative Commission Working Title: PUBLIC DEFENDER'S OFFICE, 8TH CIRCUIT- ASSISTANT PUBLIC DEFENDER -...  ...Scott, 8th Circuit Public Defender, is seeking both entry-level and experienced attorneys for the position of Assistant...