Licensed Vocational Nurse (LVN) - Utilization Review

This position may qualify for a sign-on bonus The individual in this position is responsible to facilitate effective resource coordination to help patients achieve  optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and  right to self-determination. The individual in this position has overall responsibility for ensuring that care is  provided at the appropriate level of care based on medical necessity.

This position integrates national standards  for case management scope of services including: • Utilization Management services supporting medical necessity and denial prevention  • Coordination with payers to authorize appropriate level of care and length of stay for medically necessary  services required for the patient • Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy  • Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered  services and administration of benefits The individual’s responsibilities include the following activities: a) accurate medical necessity screening and  submission for Physician Advisor review, b) securing and documenting authorization for services from payers, c)  managing concurrent disputes, d) collaborating with payers, physicians, office staff and ancillary departments, e)  timely, complete and concise documentation in the Tenet Case Management documentation system, f)  maintenance of accurate patient demographic and insurance information, g) identification and documentation of  potentially avoidable days, h) identification and reporting over and underutilization, i) and other duties as  assigned MINIMUM EDUCATION: Graduate of an accredited School of Nursing  PREFERRED EDUCATION: Associates in Nursing  MINIMUM EXPERIENCE: 2 years acute hospital or behavioral health patient care experience with at least  1 year utilization review in an acute hospital or commercial/managed care payer setting.

PREFERRED EXPERIENCE: 1 year hospital acute or behavioral health case management experience. REQUIRED CERTIFICATIONS/LICENSURE: Must be currently licensed, certified or registered to practice  profession as required by law or regulation in state of practice or policy. Active LVN/LPN license for  state(s) covered. PREFERRED CERTIFICATIONS/LICENSURE: Accredited Case Management (ACM) #LI-GF2