BHU Utilization Review LVN

Job description

Job Summary: The Utilization Review (UR) LVN supports the Mission of Pipeline Health through the provisision of disctinctive and compassionate care to our patients. This position is responsible for utilization review, including assessment of patient’s medical necessity criteria for admission and continued stay. Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) patient communication. Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. Essential Functions: - Performs initial UR within the first business day of encounter and concurrent reviews to assess for medical necessity for hospitalization and continued stay. Documents initial and concurrent reviews on review worksheets for Medicare, HMO/PPO, TARS for Medi-cal and self-pay cases. - Provides initial and concurrent reviews to health plans or designated IPA, verbal or written rep...