LPN/Utilization Review Spec

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!
 

We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South.
 

The Utilization Review Specialist, through the use of documented medical criteria and nursing knowledge and under the supervision of the Manager is responsible for coordinating and monitoring inpatient services for all aspects of patient care that pertains to hospital admission. The Utilization Review Specialist monitors healthcare services that are medically necessary, appropriate, effective and cost efficient according to hospital standards. The Utilization Review Specialist also works with the physicians to help assure appropriate documentation. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

 

Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview
The Utilization Review Specialist, through the use of documented medical criteria and nursing knowledge and under the supervision of the Manager is responsible for coordinating and monitoring inpatient services for all aspects of patient care that pertains to hospital admission. The Utilization Review Specialist monitors healthcare services that are medically necessary, appropriate, effective and cost efficient according to hospital standards. The Utilization Review Specialist also works with the physicians to help assure appropriate documentation. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What you will do

• Assesses opportunities to decrease fragmentation in health care delivery system; improves utilization of resources to improve quality of care. Assesses all patients to determine medical necessity for admission and continued stay in the appropriate level of care while remaining cognizant of the average length of stay per diagnosis for all patient populations.
• Interacts with payors for cases requiring advanced clinical knowledge and detailed knowledge of patient status. Provides clinical support personnel with appropriate clinical assessment to assure timely completion of payor reviews.
• Demonstrates initiative in identifying and pursuing opportunities for self-improvement and enhancement of professional competency.
• Demonstrates effective customer relation skills, promotes a positive work environment and contributes to the overall team effort. Establishes a good working relationship with physicians, patients and other members of the patient care team.
• Understands, applies and supports department/hospital policies, procedures and standards.

Education/Formal Training Requirements

• Technical Degree or Diploma Nursing - LPN

Work Experience Requirements

• Acute care environment
• Case Management, Care Coordination, or Utilization Management
• 5-7 years LPN

Licenses and Certifications Requirements

• Licensed Practical Nurse - Arkansas - Arkansas State Board of Nursing
• Licensed Practical Nurse - Mississippi - Mississippi Board of Nursing
• Licensed Practical Nurse - Tennessee - Tennessee Board of Nursing

Knowledge, Skills and Abilities

• Positive working relationship and excellent interpersonal skills in working with physicians required.
• Excellent written and verbal communication skills.
• Ability to plan and schedule tasks and to maintain control of own workflow.
• General PC skills.
• Previous experience with Care Management/Utilization Management software packages preferred.
• Effective interpersonal relationship skills.

Supervision Provided by this Position

• There are no lead or supervisory responsibilities assigned to this position.

Physical Demands

• Non-invasive patient contact.
• Must be able to read, write and communicate both orally and in writing to individuals in the healthcare field.
• Ability to stand, walk and sit in one place periodically throughout the shift.
• Good balance and coordination.

Our Associates are passionate about what they do, the service they provide and the patients they serve. We value family, team and a Power of One culture that requires commitment to the highest standards of care and unity.

Education:

Technical Degree or Diploma: Nursing - LPN (Required