Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)
Under the general direction of the Director of UM, UM Administrative Manager, and UM Nurse Supervisor/Educator, the Concurrent Review LVN performs concurrent or retrospective review of acute in-patient and skilled nursing facility services, as required, using established criteria to meet the contractual and regulatory requirements while acting within the scope of the Board of Vocational Nursing and Psychiatric Technicians of the State of California. The Concurrent Review LVN will promote the quality and cost effectiveness of medical care provided to patients by applying appropriate nationally recognized guidelines, criteria, and evidence-based standards. Also assists UM management and Compliance team in preparation for audits and other regulatory activities as needed.
- Acting within the scope of the Board of Vocational Nursing and Psychiatric Technicians of the State of California, performs concurrent or retrospective review of acute, sub-acute, and skilled nursing facility services in a timely and efficient manner utilizing the established criteria/protocols
- Maintains timely and accurate documentation of clinical reviews in Utilization Management software system according to EPIC Management policy and procedure
- Works closely with attending and contracting physicians, ancillary providers, facility case managers, social workers, and group medical directors to facilitate discharge planning
- Making rounds in hospitals, skilled nursing facilities, and other clinical institutions as required reviewing patient clinical progress, attending family/rehab meetings, observing therapies and treatments, and discussing care plans with clinical care teams
- Reviews medical records, facility case management reviews, and interprets criteria to ensure services provided are medically necessary and at the appropriate level of care
- Participates in the Transitions of Care program in collaboration with the Care Management Department to achieve goals of improved patient outcomes and reduce readmission rates
- Other duties as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- High School or equivalent
- Graduation from an accredited LVN school of nursing or have completed coursework allowing candidate to challenge the VN Board of Nursing and attain LVN designation
- Current State of California LVN licensure, active and in good standing
- 2+ years clinical experience in an acute or ambulatory patient care setting including 1+ years in a managed care environment such as a medical group, independent physician association, or health plan
- Knowledge of Medicare, DMHC, NCQA, and MCG Guidelines
- Proficient in the application of Microsoft Word, Excel, Outlook, and the Internet
- Valid California driver’s license and insurability under the company’s insurance carrier standards as applicable to job requirements
Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
California, Colorado, Connecticut, Nevada, Washington or New York City Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, Washington or New York City residents is $18.80 to $36.78. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.