QI Hedis Nurse

Monterey Park, CA 91754

Employment Type: Direct Job Category: Licensed Vocational Nurse LVN Job Number: 46647

Our client, a large, rapidly growing healthcare organization is in need of a Licensed Vocational Nurse UM Review nurse to review documentation and assist in denials cases for ambulatory and outpatient patients from an office setting. The Licensed Vocational Nurse must be able to comfortably use a computer and deliver information via telephone in communicating efficiently and effectively with all parties involved. This position is from an office-setting. This is a direct hire, permanent, full-time position, Mon - Fri, 8am - 5pm, with Weekends and Holidays off.

The Utilization Management Review nurse is responsible for assessing, coordinating, and adjusting individual care plans for organization s members that results in provision of quality and cost effective care. The LVN Case Manager works within the scope of the LVN and within an interdisciplinary team in delivering total care package.

Duties:

  • Monitor member plan based on assessment of health status, resource availability, past/present treatment plan, goals, and provider options.
  • Assist in coordinating services between physician, specialists, medical providers, and non-medical staff to meet the complete needs of clients.
  • Identify and report risk management quality concerns.
  • Enter and maintain assessments, authorizations, and clinical information into EMR systems.

Requirements:

  • Current California Licensed Vocational Nurse license
  • 1+ years of Utilization Management or Case Management experience
  • Knowledge of managed care/IPA/health plan/medical group preferred

Why Work Here:

  • Consistent, standard hours Mon Fri 8am 5pm with weekends and Holidays off
  • Comprehensive benefits package including 100% employee paid medical insurance premium, generous PTO, Sick Pay, Holiday Pay, 401K, FSA options, etc.
  • Very large and growing organization with several opportunities for advancement
  • Opportunity to work among interdisciplinary team as well as independently in a fast-paced, educational environment
  • Ability to manage care for variety of those in need

This is a direct-hire, permanent, full-time position with an established, large and growing healthcare organization. Please submit your resume to learn more about our client! Or, email resume directly to Kasey at kklumpp@medicalprofessionals.com.

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