Hiring UM Review Nurse in USA 2024 – Apply Now

ApolloMed is seeking an LVN Utilization Review Nurse to be stationed at 1600 Corporate Center Drive in Monterey Park. Typical weekday hours for this position are 8:30 a.m. to 5:00 p.m. Additionally, weekend and holiday coverage is necessary for business purposes. This is a hybrid position in which weekly work is to be performed both in the office and from home.

Details of Hiring UM Review Nurse in USA:

What You’ll Do:

• Perform retrospective review and prior authorization for durable medical equipment, outpatient procedures, post-homecare services, and elective inpatient admissions.
• Refer cases to Medical Directors when necessary or suitable.
• Acquire and maintain knowledge of accreditation standards and state and federal regulations.
• Adhere to internal procedures and policies
• Perform any additional responsibilities as directed

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Qualifications:

• A valid and unrestricted California LVN license
• Proficiency in operating Microsoft applications, including Word, Excel, and Outlook

You’ll be great for this Role If:

• Two (2) years of experience with a health plan, IPA, or MSO
• Excellent interpersonal abilities
• Capability to collaborate with senior management, peers, and other members of the staff
• Staff education and training expertise

Who We Are:

ApolloMed (NASDAQ: AMEH) is a technology-driven healthcare management organization with a focus on physicians. We are developing and operating an innovative, integrated, value-based healthcare delivery infrastructure that will enable our physicians to provide their patients with cost-effective, end-to-end care of the highest quality. Our overarching objective is to leverage our technological prowess, best-in-class delivery network, and clinical expertise to enhance patient outcomes, expand healthcare accessibility, and optimize the efficiency of the United States healthcare system.

At this time, our platform grants more than 12,000 physicians the ability to attend to more than 1.3 million patients across the nation. By leveraging our distinctive juncture among the three primary healthcare stakeholders—payer, provider, and patient—our expeditious expansion affords us an exceptional prospect to integrate technological and clinical prowess to enhance patient outcomes, expand quality healthcare accessibility, and diminish waste within the United States healthcare system.

Environmental Job Requirements and Working Conditions:

• This position is on a hybrid schedule. The office is located in Monterey Park.
• The target pay range for this role is $28 – $40 per hour.

ApolloMed is pleased to be an Affirmative Action and Equal Employment Opportunity employer. No discriminatory practices are tolerated based on age, legally protected characteristics, protected veteran status, disability status, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, protected veteran status, or protected individual status.

All employment decisions are made on business necessity, qualifications, and merit. To request accommodations for open positions if you need assistance due to a disability, kindly send an email to humanresourcesdept@networkmedicalmanagement.com.

Benefits of Hiring UM Review Nurse in USA:

• Energy and Resource Optimization: To ensure that healthcare resources are utilized effectively and efficiently, UM Review Nurses assist. Through the evaluation and assessment of the indispensability of medical services, procedures, and hospital admissions, they make a valuable contribution to the optimization of resource allocation in the healthcare system.
• Cost Reduction: Controlling healthcare costs is a principal objective of UM review nurses. This is achieved through the verification that medical services are both medically necessary and delivered at the appropriate standard of care. For both payers and healthcare providers, this can facilitate cost containment.
• The caliber of care: UM Review nurses contribute to the improvement and maintenance of healthcare service quality. Through the process of evaluating treatment plans for congruence with evidence-based practices, they actively participate in the provision of superior patient care.
• Promotion of Patient Advocacy: Patient advocacy is the responsibility of UM Review Nurses, who ensure that patients receive appropriate and necessary healthcare services. They strive to strike a balance between cost considerations and the patient’s best interests, thereby advancing patient-centered care.
• Adherence to Regulations and Compliance: UM Review Nurses possess a comprehensive understanding of healthcare regulations and compliance standards. The employment of a proficient UM review nurse assists healthcare organizations in upholding ethical standards in patient care and complying with regulatory mandates.
• Partnerships with Healthcare Groups: UM Review Nurses engage in collaborative efforts with a diverse array of healthcare practitioners, such as case managers, physicians, and other team members. This collaborative approach facilitates the development of coordinated and comprehensive care plans.
• Analysis and Reporting of Data: UM Review Nurses frequently conduct data analysis to discern trends, patterns, and potential areas for enhancement. This method of analysis provides healthcare organizations with invaluable insights that enable them to improve their processes and outcomes.
• Risk Administration: Critically examining and evaluating treatment plans, UM Review Nurses aid in the development of risk management strategies. This can contribute to the prevention of adverse events, readmissions, and superfluous complications, thereby enhancing patient safety.
• Ongoing Enhancement: UM Review Nurses frequently participate in initiatives for continuous quality improvement. The contributions of their feedback and insights are instrumental in the ongoing enhancement of healthcare processes and outcomes.
• Capacity to Adapt to an Evolving Healthcare Environment: The healthcare industry is a fluid and ever-evolving environment. Review nurses at UM are strategically positioned to effectively navigate the dynamic landscape of healthcare policies, technologies, and practices, thereby assisting organizations in their transition.

Additional Information:

The job description is not an employment contract between the employer and employee; rather, it reflects the evolving needs and requirements of the job and is susceptible to modification by the employer.

For More Info:

Email Your CV, and We’ll Find the Best Pathway For you: info@usavisasponsorshipjobs.com

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