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PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital – Whittier, PIH Health Hospital – Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services. The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
The LVN UM Manager’s main responsibility is to maintain compliance with the health plans, NCQA, CMS, DHCS and DMHC. This position must stay current with any health plans, CMS, DHCS, DMHC and NCQA clinical employee licensure. LVN UM Manager will be responsible for providing daily audits of staff productivity and TAT in order to maintain compliance with UM process.
Required Skills
- Strong organizational skills
- Excellent verbal and written communication skills
- Ability to work independently and manage multiple projects
- Knowledge of ICD-10, CPT and HCPCS coding
- Knowledge of NCQA, CMS, DHCS and DMHS rules and regulations
- Familiar with EZCap/EZNet
- General knowledge of health plan contract including, but not limited to, interpreting and understanding DOFRs, delegation of responsibility matrices, general contract provisions, and benefits to make accurate determinations of care
- Excellent interpersonal skills to work with staff, management, health plan personnel, and vendors
- Microsoft Office: Word, Excel, Visio and Power Point
Required Experience
Required:
- Current/unrestricted LVN license
- Minimum of 2 years inpatient, outpatient clinical, health plan, or MSO setting experience
- Minimum 2 years experience in a UM department
- Experience with working collaborative with multiple health plans
- Experience with preparing and leading health plan audits
Beyond the benefits that come with working for the area’s leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you’ll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V
