Licensed Vocational Nurse (LVN) - Utilization Review

This position may qualify for a sign-on bonus


The individual in this position is responsible to facilitate effective resource coordination to help patients achieve 
optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and 
right to self-determination. The individual in this position has overall responsibility for ensuring that care is 
provided at the appropriate level of care based on medical necessity. This position integrates national standards 
for case management scope of services including:
• Utilization Management services supporting medical necessity and denial prevention 
• Coordination with payers to authorize appropriate level of care and length of stay for medically necessary 
services required for the patient
• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy 
• Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered 
services and administration of benefits
The individual’s responsibilities include the following activities: a) accurate medical necessity screening and 
submission for Physician Advisor review, b) securing and documenting authorization for services from payers, c) 
managing concurrent disputes, d) collaborating with payers, physicians, office staff and ancillary departments, e) 
timely, complete and concise documentation in the Tenet Case Management documentation system, f) 
maintenance of accurate patient demographic and insurance information, g) identification and documentation of 
potentially avoidable days, h) identification and reporting over and underutilization, i) and other duties as 
assigned