Join Our Team: LVN, Utilization Management - Remote - El Segundo, CA
We are seeking a highly skilled and detail-oriented Licensed Vocational Nurse (LVN) to join our Utilization Management team in a remote capacity. As an LVN, Utilization Management, you will play a critical role in ensuring the quality and compliance of our health care delivery processes. This dynamic role offers the opportunity to work in a fast-paced environment focused on improving health care outcomes, while enjoying the flexibility of remote work.
About Our Company and Culture
Our organization is dedicated to delivering high-quality health care services that exceed our members' expectations. We pride ourselves on a culture of excellence, innovation, and compassion. Our team is comprised of dedicated professionals who share a passion for improving health care outcomes and making a positive impact on our community. By joining our team, you will become part of a collaborative and dynamic environment that values diversity, inclusivity, and employee growth.
Job Summary
The LVN, Utilization Management position is a remote role responsible for coordinating Health Plan Delegation Oversight audits and conducting internal quality reviews for Case Management and Utilization Management. The successful candidate will be responsible for preparing audit documentation, communicating with auditors, and facilitating compliance audits to ensure adherence to regulatory requirements.
Key Responsibilities
- Pre-Audit Documentation: Prepares and submits pre-audit documentation as outlined on Health Plan audit tools, ensuring accuracy and completeness.
- Auditor Communication: Communicates effectively with Health Plan auditors related to audit documents and processes, addressing any questions or concerns in a timely manner.
- Collaboration: Collaborates across the organization to gather necessary documentation to meet audit requirements, working closely with internal stakeholders to ensure seamless audit execution.
- Compliance Audit Reviews: Facilitates onsite, virtual, or desktop compliance audit reviews to ascertain regulatory requirements adherence, identifying areas for improvement and implementing corrective actions as needed.
- Performance Improvement: Participates in performance improvement activities, contributing to the development and implementation of process enhancements and quality initiatives.
- Internal Audits: Conducts comprehensive internal audits of the end-to-end utilization management process, evaluating the effectiveness of existing processes and identifying opportunities for improvement.
- Focused Internal Audits: Conducts focused internal audits of specific elements or process changes based on identified trends or new process implementation, ensuring compliance with regulatory requirements and internal policies.
Requirements
Education and Licensure
- Graduation: Graduation from an accredited Licensed Vocational/Practical Nurse program or completion of a vocational nursing program through the CA Board of Nursing.
- Current LVN/LPN License: Current LVN/LPN license in the state of California.
Clinical Experience
- Clinical Experience: 2+ years of clinical experience working as an LVN/LPN in a health care setting.
- Utilization Management Experience: 1+ year of utilization management experience, especially in Prior Authorization.
Nice-to-Haves
Additional Experience
- LVN/LPN Experience: 3+ years of experience working as an LVN/LPN.
- Care Management Experience: 2+ years of care management, utilization review, or discharge planning experience.
Managed Care Experience
- HMO or Managed Care Setting: Experience working in an HMO or Managed Care setting.
- Basic Knowledge: Basic knowledge of requirements for Medicare, Medi-Cal, and Commercial lines of business.
Skills and Competencies
To succeed in this role, you will need:
- Excellent Communication: Strong written and verbal communication skills, with the ability to effectively communicate with auditors, internal stakeholders, and other health care professionals.
- Attention to Detail: High level of accuracy and attention to detail, with the ability to review and analyze complex documentation.
- Analytical Skills: Strong analytical skills, with the ability to evaluate data and identify trends and areas for improvement.
- Organizational Skills: Excellent organizational skills, with the ability to prioritize tasks and manage multiple projects simultaneously.
- Collaboration: Ability to work collaboratively with internal stakeholders and external auditors to achieve audit goals.
Career Growth Opportunities and Learning Benefits
We are committed to the growth and development of our employees. By joining our team, you will have access to:
- Training and Development: Ongoing training and development opportunities to enhance your skills and knowledge.
- Career Advancement: Opportunities for career advancement and professional growth within the organization.
- Mentorship: Access to experienced mentors who can provide guidance and support.
Work Environment and Company Culture
We offer a dynamic and supportive work environment that values:
- Remote Work: The flexibility to work from home or a remote location.
- Collaboration: A collaborative and inclusive work environment that encourages teamwork and innovation.
- Diversity and Inclusion: A commitment to diversity, equity, and inclusion, with a focus on creating a workplace that is welcoming and inclusive for all employees.
Compensation, Perks, and Benefits
We offer a comprehensive benefits package, including:
- Competitive Salary: A competitive salary range for this role.
- Comprehensive Benefits: A comprehensive benefits package, including medical, dental, and vision coverage.
- Incentive Programs: Incentive and recognition programs to reward outstanding performance.
- Equity Stock Purchase: An equity stock purchase plan to help you build ownership in our company.
- 401k Contribution: A 401k contribution plan to help you save for retirement.
Conclusion
If you are a motivated and detail-oriented LVN with a passion for quality improvement and compliance, we encourage you to apply for this exciting opportunity. As an LVN, Utilization Management, you will play a critical role in ensuring the quality and compliance of our health care delivery processes, while enjoying the flexibility of remote work and a comprehensive benefits package. Apply today to join our team and make a positive impact on the lives of our members!
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