Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
AppleCare Medical Management Group was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same.
Today, AppleCare Medical Management is comprised of hundreds of board - certified private - practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.
As a part of our continued growth, we are searching for a new LVN to join our team!
Outpatient/ambulatory referral management; including decision - making activities that include the application of criteria and clinical standards of care
Medical record review
Review and analysis of diagnostic testing results
Case discussion with physicians/providers
Identification and communication of utilization trends both over/under utilization
Act as a team leader for specialty team
Participate in U.M studies and QI activities
Care coordination including patient education and compliance follow up
Identify process improvement opportunities and assists in the implementation of process improvement
Participate in all meetings as required
Prepare and present educational topics to committees and/or staff
Identify and refer members that meet case management, palliative care and/or hospice criteria
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 diploma or GED
Active, unrestricted LVN license in the state of California
1+ years of expierince working as a LVN
Microsoft Word and Excel proficiency
General knowledge of IPA Operations
Familiar with various financial risk arrangements
1+ year of utilization review experience as an LVN
Knowledge of Medical Management, CMS, HMO, Medi - Cal UM and QM processes
Knowledge of and experience with UM criteria such as using the CMS database for national and local determinations, nationally recognized criteria such as MCG, health plan criteria
AppleCare Medical Management Group was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
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.
Job Keywords: Utilization, LVN, nursing, utilization review, utilization management, California, CA, La Palma, Cerritos, Cypress