LVN- UM Review in Los Angeles, California

NAT
NAT
4 Min Read

Robert Half


Description

We are seeking a UM Review Nurse to ensure the quality and cost-efficiency of medical care by applying clinical knowledge and implementing policies and guidelines for emergency, urgent and continued stay evaluations. The detailed examination of medical necessity and level of care for required services will be part of your daily tasks, where, based on case findings, you may need to refer to Medical Directors for reviews.

Duties & Responsibilities: • Facilitate, coordinate and approve medical referrals that meet specific criteria as a Utilization Management Nurse Specialist RN • Ensure timely and exact referral determinations and notifications based on the referral status • Prepare and generate approval, alteration, and refusal communications to notify members and providers of referral determination • Monitor any inpatient setting admissions actively • Conduct telephic and/or on-site review for admission and concurrent review, work in collaboration with onsite staff, physicians, providers, members/family to get a successful discharge plan • Collaborate with the UM Director and Medical Director for case reviews for pre-service, concurrent, post-service, retrospective claims medical review, and occasionally, appeals • Function as a department guide for medical service requests/referral management and procedures • Handle incoming calls from providers, deal with complex calls professionally, and research to find accurate and timely resolution steps • Follow-up with the caller to provide a response or resolution steps • Answer all inquiries professionally and courteously • Support team engagement, programs, and events to encourage a positive and productive workplace • Generate proper member and provider communication for all determinations within the deadlines outlined by the latest department policy.

Requirements

Active LVN license

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity – whenever you choose – even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.

All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https:///www.roberthalf.com/us/en/terms) .


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