Utilization Management Nurse Specialist, LVN FT Days

The UM Nurse Specialist provides organizational support in the Utilization Management Department; efficiently processes Pre-Service Authorization Requests. Works with UM Coordinators. 

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 Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

• 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.
• Attention to detail is a must

Required Experience

Required:

• High school diploma or GED
• Active California LVN License
• Minimum two years’ experience in a health plan or managed care IPA or Medical Group in UM.

Preferred:

• Passed the Bilingual Fluency Assessment for Clinicians (BFAC Certified) by Language Line Solutions
• Experience writing denial letters