LVN, Utilization Management Nurse Specialist, PIH Health Physicians, Full Time, Day Shift
Location: Whittier, California
Internal Number: 15814
PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services. The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM.
The UM Nurse Specialist provides organizational support in the Utilization Management Department; efficiently processes Pre-Service Authorization requests within regulated turn-around times. Works closely and efficiently with UM Coordinators.
Current knowledge of Managed Care and Health Plan Division of Financial Responsibilities (DOFR)
Ability to apply appropriate UM criteria
Excellent communication skills
Strong organizational capabilities.
Formal training will be indicated by a high school diploma or equivalent
Current licensure as an LVN in the state of California.
Minimum of two years’ experience in a health plan or managed care IPA or Medical Group in UM.
Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V