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Located in the heart of the Coachella Valley, you have access to resort-style living and world-class amenities throughout Southern California.

  • Job Objective: A brief overview of the position.
    • •    The Utilization Review Nurse LVN will use skilled intervention and clinical best practice to concurrently screen admission review and review with payors in collaboration with Case Management for utilization issues. In addition, the UR LVN will disseminate information to improve service to patients/members, their families, and all staff members. Will do UR and enter data in EPIC.

  • Reports to
    • MANAGER, CASE MANAGEMENT
  • Supervises
    • N/A
  • Ages of Patients
    • Pediatric
    • Adolescent
    • Adult
    • Geriatric
  • Blood Borne Pathogens
    • Minimal/No Potential
  • Qualifications
    • Education
      • Preferred: Bachelor’s degree in healthcare related field
    • Licensure/Certification
      • Required: Licensed Vocational Nurse in the State of California
    • Experience
      • Required: Three (3) years of LVN or Case Management experience

  • Essential Responsibilities
    • Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
    • Ensures appropriate authorization for commercial patients.
    • Serves as the first line responder to payor’s clinical questions and for approval for admission, per established process. Manages the payor line appropriately.
    • Ensures appropriate demographic information has been communicated and pre-certification/verification obtained.
    • Contacts UR Nurse when requests for reviews come in.
    • Completes Medical Necessity reviews, documenting in electronic medical record according to established policies and procedures

    • Calls, faxes or electronically transmits reviews to payors.
    • Ensures authorization information is being communicated to the business office, per established processes.
    • Keeps attending physician updated and aware of authorization status. Notifies attending physician of any change in authorization status.

    • Follows up with payors to obtain authorization, after discharge
    • Enters all appropriate authorization issues for follow-up.
    • Tracks any outstanding authorization issues for follow-up.
    • Provides notification of discharges to insurance payors.
    • Notifies the UR Nurse and Denials Coordinator of potential denials.
    • Supports the denials coordinator to manage retrospective appeals and documents according to established policy.
    • Coordinates physician reviews with the UR Nurse, inpatient case manager and appropriate physicians for the denials management process.
    • Performs other duties as assigned.
       

Eisenhower Health offers a generous benefits package and a matched retirement plan.

Employees are eligible to participate in a benefits program designed to make a difference for you and your family.

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A Culture of Positivity and Support

From the beginning, this organization formed a culture based on strong values, commitments and a passion for service and professional excellence.

What Our Nurses Say

One of my very favorite things about working at Eisenhower Health is the culture on inclusivity that we have and a strong base for evidence-based practice.

Lori

Neonatal Nurse

One of the greatest things about working as a nurse at Eisenhower Health is how much support you get from Administration. We keep on improving the process here. It's a fantastic place to work.

Richard

Nursing Supervisor

My favorite thing about working at Eisenhower Health is the camaraderie within my unit and with the different departments.

Jennifer

Registered Nurse

Be a Part of an Award-Winning Team

Magnet Recognized 2024-25 Best Regional Hospital Geriatric Accredited Watson Health Top 50 Cardiovascular Hospitals
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