Utilization Review Nurse - LVN/LPN Job at Personify Health

Utilization Review Nurse LVN/LPN

Under the supervision of a registered nurse the Utilization Review Nurse will pr...

Location

United States

Salary:

25.00 - 30.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

Current LVN license in the United States or U.S. territory
1+ years of clinical experience required
Knowledge of medical claims and ICD-10, CPT, HCPCS coding
Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint and Outlook
Excellent verbal and written communication skills
Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

Job Responsibility

Provide first level review for all outpatient and ancillary pre-certification requests for medical appropriateness
all inpatient hospital stays including mental health, substance abuse, skilled nursing and rehabilitation for medical necessity
and all post claim or post service reviews
Ensure proper referral to medical director for denial authorizations through independent review organizations (IRO)
Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care
Refer requests that fall outside of established guidelines to advance review or senior care consultants
Process appeals for non-certification of services
complete non-certification letters when appropriate
Review plan document for benefit determinations
attempt to redirect providers and patients to PPO providers

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions (yes, we use what we build)
Paid Time Off—rest and recharge time is non-negotiable
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

Fulltime

Licensed Nurse Care Coordinator - Population Health

An LVN/ LPN plays a crucial role in managing patient care and ensuring continuit...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High school diploma required
Minimum of 3 years of clinical or home health experience required
LVN/LPN in the state of employment and/or compact licensure required
Knowledge of government programs (CMS), accountable care organizations (ACOs), HEDIS, and experience with payor cost sharing initiatives preferred
Knowledge of physician office practice operations and one year of experience in physician practice is preferred
Proficiency in keyboarding and EHR systems, primarily Epic

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Identify quality gaps. Participate in Quality Improvement Programs as indicated
Support Primary Care Providers and assist patients in scheduling preventative screenings and appropriate appointments. Maintain ongoing communication with healthcare providers through various tools and meetings
Value-based care quality performance and pulls reports to identify open care gaps. Conducts telephonic outreach on behalf of providers to close care gaps & address medication adherence to facilitate star rating and quality performance
Providing counseling and health education to patients and families, using appropriate materials and standardized protocols. Serve as a subject matter expert in care transitions & quality metrics. Assist in educating practice staff on quality, payor, and government program requirements
Communicate resources and services available to patients through the continuum of care
Escalate health concerns to Primary Care providers and place referrals to appropriate care team members, i.e., Nurse Navigation, CHW, etc. Develop professional working relationships with ACO and CIN network providers, practice managers, and their staff to collaboratively manage follow-up care and improve overall health and wellness
Document relevant, comprehensive information and data using standard assessment tools. Maintain patient chart compliance through proper documentation and updated: preventative screenings, medical history, medication, and immunizations
Unburden primary care providers by placing approved orders for labs and other screenings as per the Standing Delegated orders
Perform Transition of Care calls on patients transitioning from an inpatient stay to home, or emergency department encounter to identify the need for a follow-up appointment, community resource needs, scheduling follow-up appointments, reviewing discharge instructions, and medications. Utilizing clinical judgment and problem-solving skills to coordinate appropriate care with physicians and Nurse Navigation

Fulltime

Licensed Nurse Care Coordinator - Population Health

An LVN/ LPN plays a crucial role in managing patient care and ensuring continuit...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High school diploma required
Minimum of 3 years of clinical or home health experience required
Knowledge of government programs (CMS), accountable care organizations (ACOs), HEDIS, and experience with payor cost sharing initiatives preferred
Knowledge of physician office practice operations and one year of experience in physician practice is preferred
Proficiency in keyboarding and EHR systems, primarily Epic
LVN/LPN in the state of employment and/or compact licensure required

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Identify quality gaps. Participate in Quality Improvement Programs as indicated
Support Primary Care Providers and assist patients in scheduling preventative screenings and appropriate appointments. Maintain ongoing communication with healthcare providers through various tools and meetings
Value-based care quality performance and pulls reports to identify open care gaps. Conducts telephonic outreach on behalf of providers to close care gaps & address medication adherence to facilitate star rating and quality performance
Providing counseling and health education to patients and families, using appropriate materials and standardized protocols. Serve as a subject matter expert in care transitions & quality metrics. Assist in educating practice staff on quality, payor, and government program requirements
Communicate resources and services available to patients through the continuum of care
Escalate health concerns to Primary Care providers and place referrals to appropriate care team members, i.e., Nurse Navigation, CHW, etc. Develop professional working relationships with ACO and CIN network providers, practice managers, and their staff to collaboratively manage follow-up care and improve overall health and wellness
Document relevant, comprehensive information and data using standard assessment tools. Maintain patient chart compliance through proper documentation and updated: preventative screenings, medical history, medication, and immunizations
Unburden primary care providers by placing approved orders for labs and other screenings as per the Standing Delegated orders
Perform Transition of Care calls on patients transitioning from an inpatient stay to home, or emergency department encounter to identify the need for a follow-up appointment, community resource needs, scheduling follow-up appointments, reviewing discharge instructions, and medications. Utilizing clinical judgment and problem-solving skills to coordinate appropriate care with physicians and Nurse Navigation

Fulltime

Licensed Nurse Care Coordinator - Population Health Admin

An LVN/ LPN plays a crucial role in managing patient care and ensuring continuit...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High school diploma required
Minimum of 3 years of clinical or home health experience required
Knowledge of government programs (CMS), accountable care organizations (ACOs), HEDIS, and experience with payor cost sharing initiatives preferred
Knowledge of physician office practice operations and one year of experience in physician practice is preferred
Proficiency in keyboarding and EHR systems, primarily Epic
LVN/LPN in the state of employment and/or compact licensure required

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Identify quality gaps. Participate in Quality Improvement Programs as indicated
Support Primary Care Providers and assist patients in scheduling preventative screenings and appropriate appointments. Maintain ongoing communication with healthcare providers through various tools and meetings
Value-based care quality performance and pulls reports to identify open care gaps. Conducts telephonic outreach on behalf of providers to close care gaps & address medication adherence to facilitate star rating and quality performance
Providing counseling and health education to patients and families, using appropriate materials and standardized protocols. Serve as a subject matter expert in care transitions & quality metrics. Assist in educating practice staff on quality, payor, and government program requirements
Communicate resources and services available to patients through the continuum of care
Escalate health concerns to Primary Care providers and place referrals to appropriate care team members, i.e., Nurse Navigation, CHW, etc. Develop professional working relationships with ACO and CIN network providers, practice managers, and their staff to collaboratively manage follow-up care and improve overall health and wellness
Document relevant, comprehensive information and data using standard assessment tools. Maintain patient chart compliance through proper documentation and updated: preventative screenings, medical history, medication, and immunizations
Unburden primary care providers by placing approved orders for labs and other screenings as per the Standing Delegated orders
Perform Transition of Care calls on patients transitioning from an inpatient stay to home, or emergency department encounter to identify the need for a follow-up appointment, community resource needs, scheduling follow-up appointments, reviewing discharge instructions, and medications. Utilizing clinical judgment and problem-solving skills to coordinate appropriate care with physicians and Nurse Navigation

Fulltime

Licensed Nurse Care Coordinator - Population Health

An LVN/ LPN plays a crucial role in managing patient care and ensuring continuit...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High school diploma required
Minimum of 3 years of clinical or home health experience required
Knowledge of government programs (CMS), accountable care organizations (ACOs), HEDIS, and experience with payor cost sharing initiatives preferred
Knowledge of physician office practice operations and one year of experience in physician practice is preferred
Proficiency in keyboarding and EHR systems, primarily Epic
LVN/LPN in the state of employment and/or compact licensure required

Job Responsibility

Identify quality gaps. Participate in Quality Improvement Programs as indicated
Support Primary Care Providers and assist patients in scheduling preventative screenings and appropriate appointments. Maintain ongoing communication with healthcare providers through various tools and meetings
Value-based care quality performance and pulls reports to identify open care gaps. Conducts telephonic outreach on behalf of providers to close care gaps & address medication adherence to facilitate star rating and quality performance
Providing counseling and health education to patients and families, using appropriate materials and standardized protocols. Serve as a subject matter expert in care transitions & quality metrics. Assist in educating practice staff on quality, payor, and government program requirements
Communicate resources and services available to patients through the continuum of care
Escalate health concerns to Primary Care providers and place referrals to appropriate care team members, i.e., Nurse Navigation, CHW, etc. Develop professional working relationships with ACO and CIN network providers, practice managers, and their staff to collaboratively manage follow-up care and improve overall health and wellness
Document relevant, comprehensive information and data using standard assessment tools. Maintain patient chart compliance through proper documentation and updated: preventative screenings, medical history, medication, and immunizations
Unburden primary care providers by placing approved orders for labs and other screenings as per the Standing Delegated orders
Perform Transition of Care calls on patients transitioning from an inpatient stay to home, or emergency department encounter to identify the need for a follow-up appointment, community resource needs, scheduling follow-up appointments, reviewing discharge instructions, and medications. Utilizing clinical judgment and problem-solving skills to coordinate appropriate care with physicians and Nurse Navigation
Must have exceptional oral communication skills, strong organizational skills, and ability to adapt to change

Fulltime

New

Facilities Technician

Are you ready to bring your technical expertise to a place where "impossible" is...

Location

United Kingdom , Plymouth

Salary:

34000.00 - 38000.00 GBP / Year

Randstad

Expiration Date

June 11, 2026

Requirements

Completed apprenticeship with a Level 3 technical/vocational qualification or Level 3 Diploma in a relevant field
Ideally hold BS 7671 - 18th Edition
City & Guilds 2391, 2394, or 2395 is a distinct advantage
Up to 2 years of experience in electrical facilities, including building services like Fire Systems and Building Fabric
Strong understanding of BMS systems, HVAC, boilers, and emergency lighting
Proficient PC skills for report writing and ordering parts, with the ability to assess the urgency of safety-critical vs. routine tasks

Job Responsibility

Execute Planned Preventative Maintenance (PPM), reactive repairs, and breakdown works across all mechanical and electrical systems
Demonstrate expert knowledge of HV/LV electrical services, control panels, AHUs, pumps, and motors
Utilise BMS systems and alarm data to diagnose and resolve equipment issues swiftly
Operate Permit to Work systems and maintain a safe, healthy working environment, including strict adherence to PPE and H&S procedures
Supervise sub-contractors, provide parts lists/timescales for remedial works, and ensure all plant rooms are secure and tidy
Maintain flexibility to respond to emergencies or critical BMS alarms at the end of the day when necessary

Fulltime

New

Children's Social Worker

A dedicated and experienced Qualified Children's Social Worker is required to jo...

Location

United Kingdom , Wigan

Salary:

36.00 - 38.00 GBP / Hour

Randstad

Expiration Date

June 10, 2026

Requirements

Social Work Qualification: A Degree/Diploma in Social Work or equivalent
Professional Registration: Current and valid registration with Social Work England (SWE)
Experience: Significant post-qualifying experience (typically 2+ years is preferred for locum rates) within a statutory Children's Social Work setting (e.g., R&A, Long-Term, Court Team)
Legislation Knowledge: Expert working knowledge and practical application of the Children Act 1989/2004, relevant safeguarding procedures (e.g., Working Together 2018), and care planning regulations
Skills: Excellent analytical, assessment, report-writing, and communication skills. Proven ability to work autonomously, manage high levels of risk, and prioritise a demanding workload
Travel: Full UK driving licence and access to a vehicle for work purposes to cover the Wigan area (essential for home visits and meetings)
be able to manage challenging situations,be person centred
university
BA in social work

Job Responsibility

Manage a varied and complex caseload involving statutory work from initial referral through to closure, including CIN, CP, and LAC cases
Undertake high-quality, comprehensive single assessments, risk assessments, and assessments of parental capacity, ensuring timely completion in line with statutory guidance
Lead on Section 47 Enquiries, attend and prepare reports for Child Protection Conferences, and implement and review robust Child Protection Plans
Initiate and manage care proceedings, prepare all necessary reports (e.g., statements, evidence, court directions), and attend court hearings. Develop, implement, and review personalised LAC Care Plans to secure permanence and stability
Engage directly with children and young people to ascertain their wishes and feelings (using the relevant tools and models) and ensure their voices are central to the planning process
Collaborate effectively with partner agencies such as Health, Education, Police, and the Voluntary Sector to ensure a coordinated and holistic approach to service delivery
Maintain accurate, defensible, and contemporaneous case records on the electronic case management system, complying with statutory timescales and departmental procedures
Attend regular supervision and demonstrate a commitment to continuous professional development and reflective practice

Fulltime

New

Property Management Assistant

Location

United Kingdom , Bristol

Salary:

Not provided

Randstad

Expiration Date

June 11, 2026

Requirements

Well developed interpersonal and oral communications skills
Customer focused
Ability to multi-task
Very strong organisation skills
Ability to work on own initiative
Good numerical skills
Diplomacy
Ability to prioritise workload and work under pressure
Good knowledge of Microsoft office software

Job Responsibility

Answering residents queries referring to property manager where applicable
Invoice processing
Meet contractors and residents on site when necessary
Letters and reports
Carry out property inspections when required
Ensure mail is dealt within the team (paper & electronic)
Ensure telephones are answered and clear messages are taken
Ensure where possible that all enquiries are dealt with rather than referring the enquiry elsewhere
Assist administrative tasks to ensure a high level delivery of service
Support your team with all aspects of the service

What we offer

25 days holidays per annum

Select Country

Utilization Review Nurse - LVN/LPN

Personify Health

Location:
United States

Category:
Nursing

Contract Type:
Employment contract

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
May 03, 2026

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Utilization Review Nurse - LVN/LPN

Personify Health

Location:United States

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Job Posted:May 03, 2026

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