PEOPLE. PASSION. PURPOSE. 

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients.

We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.  

We are looking for a RN/LPN UTILIZATION MANAGEMENT.  If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Las Vegas, Nevada, then you should consider joining our team.

OVERALL PURPOSE:

The UM RN/LPN is responsible for compliance with the Medical Management Program Description of P3 Health Partners regarding Utilization Review, inclusive of prior authorization, concurrent and retrospective review, discharge planning and transitions of care to the appropriate level.   The UM Nurse adheres to the standard operating procedures that support achieving the Quadruple Aim:  improved outcomes, improved patient experience, improved clinician experience and decreased cost of care.  The UM Nurse will integrate the functions of utilization review, discharge planning and resource management into a singular effort to ensure, based on patient assessment and best practice, that care is provided in the appropriate setting utilizing medically indicated, contracted resources.   

EDUCATION AND EXPERIENCE:

• Graduate from an Accredited School of Nursing.   Bachelor’s degree in Nursing preferred.   

• Ability to obtain and maintain current registration to practice as a  Professional Nurse in the states where P3 has contracts.

• Minimum two years of clinical nursing experience, including a minimum of two years in a managed care/HMO organization.  

• Proficient with computer and software programs (e.g.; Microsoft Word, Excel) and the Internet required.

•  Experience applying medical management treatment guidelines and nationally recognized criteria, such as InterQual / McKesson, MCG, or other practical management guidelines required.

ESSENTIAL FUNCTIONS:

• Promote the mission, vision and values of P3 Health Partners
• Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies and approve services as per policy or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
• Obtain additional clinical information from requesting provider or other sources when necessary for determinations
• Complete medical necessity and level of care reviews for requested services using clinical judgment.  Refer to Medical Directors for review depending on case findings
• Collaborate with various staff within provider networks and Medical Management teams electronically or telephonically to coordinate care
• Educate providers on utilization and Medical Management processes
• Provide clinical knowledge and act as a clinical resource to non-clinical team
• Enter and maintain pertinent clinical information in various Medical Management systems
• Address gaps in care