One of the biggest healthcare ACO's in the DFW area is looking for a UM LVN for their company. Please see below for job description and apply if interested!

MUST BE LOCAL TO TEXAS/DALLAS-FORT WORTH

Duties

• Accountable for performing initial, concurrent, or post service review activities; discharge care coordination; and assisting with efficiency and quality assurance.
• Serve as a liaison between providers/ facilities and Care Management Division.
• Completes documentation in a timely, complete, and accurate manner in accordance with
  • (a) eligibility and benefits
  • (b)clinical guidelines/criteria
  • (c) legal and regulatory requirements.
• Identifies and refers complex risk members to case management.
• Accurately applies decision support criteria.
• Implements discharge plan to prevent avoidable days or delays in discharge.
• Transitions patients to next level of care in coordination with facility Discharge Planner.
• Identifies documents and refers cases to the Physician Advisor for medical review when services do not meet medical necessity criteria, and/or appropriate level of care, and/or potential quality issues.

This role is fully REMOTE but they would like to recruit local to DFW as the candidate may need to travel onsite for equipment needs.

• The ideal candidate will have SNF experience either as a MDS coordinator or UM experience with a Healthplan

• Graduate of an accredited School of Nursing, LVN
• Utilization management experience in an acute or post-acute provider, health plan or other care company.

• Experience in health plan utilization review, discharge planning and medical case management.
• Knowledge of specific regulatory, managed care requirements, and strong attention to detail.

• Patient-Centered
• Team Player
• Reliable

M-F 8-5pm

Business Casual

#MedixSouth