LVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Emanate Health. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice.Current Emanate Health Employees - Please log into your Workday account to applyEveryone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals.On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country.Job SummaryThe Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews. You will document decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings.Job RequirementsMinimum Education Requirement:Minimum Experience RequirementMinimum of three years of utilization management experience. Experience in quality- related job preferred. Computer proficiency is required. Excellent customer service skills required.Minimum License RequirementCurrent California LVN license.Delivering world-class health care one patient at a time.Pay Range$31.03 - $46.54We are more than just a health system. At Emanate Health, we are a catalyst for change and a beacon for healthier lives.When you come to any one of our locations (https://www.emanatehealth.org/locations/) , you'll be treated like family. And as part of our family, you can rest easy knowing we'll do whatever it takes to benefit your health and wellness.Our missionEmanate Health exists to help people keep well in body, mind and spirit by providing quality health care services in a safe, compassionate environment.Our visionWe are an integral partner in elevating our communities' health.Our valuesPatients and their families are the reason we are here. We want them to experience excellence in all we do through the quality of our services, our teamwork, and our commitment to a caring, safe and compassionate environment.Respect. We affirm the rights, dignity, individuality and worth of each person we serve and of each other.Excellence. We maintain an unrelenting drive for excellence, quality and safety, and strive to continually improve all that we do.Compassion. We care for each person and each team member as part of our family.Integrity. We believe in fairness and honesty and are guided by our code of ethics.Stewardship. We wisely care for the human, physical and financial resources entrusted to us.Emanate Health is an Equal Opportunity Employer and does not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify the Human Resources Department by calling 626-858-8515.If you have questions about this posting, please contact support@lensa.com