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JOB DETAILS

Utilization Specialist LVN

Job Ref: 27994

Talent Area: LVN

Location:
Houston Methodist San Jacinto Hospital
Baytown, TX 77521

Area/Department: Performance Improvement

Employment Type: Regular

Job Type: PRN

Organization: Houston Methodist

Work Shift: 8a- 5p, or 7a-4p

Work Week

PRN -  A minimum of 1 shift per week as needed



Company Profile

Houston Methodist San Jacinto Hospital, located 35 miles southeast of Houston, is the area's only full-service hospital offering specialized medical care for patients at every stage in life. This 392 licensed bed hospital with 18 operating rooms, and over 1,400 employees, brings Medical Center excellence and quality care close to East Harris and surrounding counties.


Job Summary

Performs utilization review activities for assigned patients; facilitates direct admissions, performs assigned clerical duties.  Work with the physicians and multidisciplinary care team to facilitate efficient, quality care and achievement of desired treatment outcomes. Communicate clinical information to payers to ensure reimbursement.  Collaborates with Performance Improvement to collect and analyze patient care and fiscal data related to target case types.


DUTIES AND RESPONSIBILITIES

1. Facilitates Direct Admissions and transfers into facility to include appropriate level of care and payer approval in conjunction with Patient Access Dept.

2. Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization and continued stay; documents findings based on standards on UR Worksheet.

3. Works collaboratively and maintains active communication with physicians, nursing and other members of the multidisciplinary care team to effect timely patient management, addresses and resolves process problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge.

4. Identifies barriers affecting timely patient management and documents avoidable days.

5. Facilitate communication with payers and external Case managers by documenting days certified proactively and concurrently resolving any denied days or delays.

6. Assist physicians, care providers, and patient/family in understanding payer plans and  benefits.

7. Performs utilization management and monitors appropriate resource utilization, continued stay authorization and documents findings based on standards in Meditech.

8. Demonstrates the components of the I CARE values statement (Integrity, Compassion, Accountability, Respect, Excellence).

9. Demonstrates ServicePRIDE standards ( Smile and make eye contact; greet each patient and visitor; seek out patient and visitor contact; displays appropriate body language at all times; take 5 minutes each day to go above and beyond for one patient or visitor; honor diversity; thanks every customer.)

10. Follows all safety rules while on the job.  Reports accidents promptly and corrects minor safety hazards.

11. Perform other duties as assigned.


EDUCATION REQUIREMENTS
Satisfactory completion of LVN program

EXPERIENCE REQUIREMENTS
3-5 years clinical experience in direct patient care setting
Prefer 2-5 years in Utilization Management

CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
Current license to practice as LVN in the State of Texas

SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

Advanced communication, negotiation and collaboration skills.
Computer skills with intermediate level expertise on MS Office Suite
Organization/time management and prioritization skills
Knowledge of healthcare financial and payer requirements, as well as regulatory agencies (Medicare, Medicaid, JCAHO) guidelines


Equal Employment Opportunity

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of  race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.

VEVRAA Federal Contractor – priority referral Protected Veterans requested.