Utilization Mgmt LVN
Harris Health is a nationally recognized health system comprising three teaching hospitals and an extensive network of ambulatory care centers serving the people of Harris County, Texas, since 1966. Staffed by the faculty, fellows and residents from two nationally ranked medical schools, Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth), Harris Health is the first healthcare system in Houston to receive the prestigious National Committee for Quality Assurance (NCQA) designation for its network of patient-centered medical homes.
Each year, Harris Health provides more than 1.8 million total outpatient visits through its more than 40 ambulatory care facilities. Additionally, Harris Health sees more than 177,000 emergency visits at its Level 1 and Level 3 trauma centers and 35,000 hospital admissions through its two hospitals: Ben Taub and LBJ.
Established by voter referendum to enhance the level of charity care available in the community, Harris Health System has often received national recognition for serving those in need and for its achievements in operational excellence, such as being named to the 2011, 2012, 2013 and 2014 Most Wired Hospitals lists by the American Hospital Association’s Hospitals & Health Networks magazine.
Additionally, Harris Health System is pleased that each of its hospitals — Ben Taub and Lyndon B. Johnson — achieved Pathway to Excellence™ designation by the American Nurses Credentialing Center.
Skills / Requirements
JOB SUMMARY: Manages Requests for Outside Services. Applies Screening Criteria for Harris Health eligible patients. Secures authorization for third party payers by providing pertinent clinical documentation according to payer guidelines. Communicates with clinic staff regarding insurance denials and impending insurance authorization expirations. Facilitates peer to peer review between the clinical staff and the payer for denied cases. Enters authorization information into EPIC Telephone Encounters. Schedule patients for outsourced procedures. Follows up with test results and ensure placement in EPIC for physician retrieval. Strong written and verbal skills are necessary in order to communicate with clinical staff and payers.
Education/Specialized Training/Licensure: LVN in good standing, currently licensed in the State of Texas without stipulations in practice.
Work Experience (Years and Area): Minimum 3 years of hospital experience in various clinical areas. 1 year utilization review, authorization or case management experience necessary. Knowledgeable with hospital coding and billing processes preferred. Knowledge of Interqual/Milliman guidelines preferred. EPIC EMR experience preferred.
Management Experience (Years and Area): Preferred but not necessary.
Equipment Operated: PC functions, calculator, general office equipment.
Communication Skills: Above Average Verbal (Heavy Public Contract), Exceptional Verbal (e.g., Public Speaking), Writing /Composing: Correspondence, Reports
Other Skills: Analytical, Mathematics, Medical Terms, P.C., Word
Work Schedule: Flexible
Other Requirements: Requires travel to HCHD facilities. Must be able to interact successfully in a culturally diverse environment.