Nurse Coordinator (LVNs Only) needed for a temp opportunity with Yoh’s client located in San Francisco, CA! **WORK FROM HOME**
Top Skills Should You Possess:

• Current (LVN) Licensed Vocational Nurse
• LVN with 2-3 years experience to include one (1) year managed care (utilization management) experience; or equivalent combination of education and experience. General knowledge of managed care with emphasis in UM preferred.
• Must be in Northern California

What You’ll Be Doing:

• Conducts retrospective claims review, either in the aggregate or on an individual Provides summaries of findings to the Team Manager UM.
• Evaluates appropriateness of care through interpretation of benefits as outlined in Title 22, Medi-Cal Provider Manual, DMHC and/or CMS regulatory requirements and PHC policies and procedures for each product line.
• Recommends and coordinates interventions to facilitate high quality, cost-effective care, monitoring treatment, progress and outcomes of patients.
• Documents and maintains patient-specific utilization management records in database and files.
• Assists in the refinement/improvement of the HS Participates in continuous process improvement endeavors.
• Works with other PHC departments to resolve issues relating to authorization of medical
• Audits medical records as
• Performs inter-rater reliability audits as directed by department
• Elicits medical information from providers and medical records and applies clinical judgement to determine medical necessity and provide timely reports/authorizations for recommended treatment.
• Refers cases that do not meet criteria on to the PHC HS department manager, director or Chief Medical Officer as appropriate.
• Participates in special projects and assignments as
• Hrs- M-F, 8a-5p

What You Need to Bring to the Table:

• Current (LVN) Licensed Vocational Nurse
• LVN with 2-3 years experience to include one (1) year managed care (utilization management) experience; or equivalent combination of education and experience. General knowledge of managed care with emphasis in UM preferred.
• Excellent written and verbal communication skills with ability to read and interpret benefit contract specifications.
• Daily use of telephone and computer for most of the day. Cubicle work station. Ability to use a computer Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs.
• Valid California driver’s license and proof of current automobile insurance
• Knowledge of utilization management programs as related to use of pre-set criteria and protocols. Familiarity with business practices and protocols with ability to access data and information using automated systems.
• Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and meeting deadlines. Strong organizational skills required.
• High-school diploma or GED.

Any pay ranges displayed are estimations which may have been provided by job boards. Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description. All qualified applicants are welcome to apply.
What’s In It For You?
We welcome you to be a part of the largest global staffing companies to meet your career aspirations. Yoh’s network of client companies has been employing professionals like you for over 65 years in the U.S., UK and Canada. Join Yoh’s extensive talent community that will provide you with access to Yoh’s vast network of opportunities.

• Medical, Dental & Vision Benefits
• 401K Retirement Saving Plan
• Life & Disability Insurance
• Direct Deposit & weekly EPayroll
• Employee Discount Programs
• Referral Bonus Programs

What are you waiting for? Apply Now!
Recruiter: Arlet Khachikyan
Yoh makes finding and applying for jobs simple. Partner with Yoh to find the right opportunities across multiple industries in the US and UK. Find out more here!
Note: Any pay ranges displayed are estimations. Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description. All qualified applicants are welcome to apply.
Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Visit https://www.yoh.com/applicants-with-disabilities [1]to contact us if you are an individual with a disability and require accommodation in the application process.
Links:
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[1] https://www.yoh.com/applicants-with-disabilities
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