Licensed Vocational Nurse - Hybrid
- Sacramento, CA
- $40.00-43.00 per hour
- Permanent
- Full-time
- Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and discharges
- Apply CMS regulations and evidence-based criteria (MCG, InterQual) to evaluate medical necessity
- Collaborate with hospital teams, providers, IPA case managers, and health plan representatives
- Conduct in-person hospital rounds 2–3 days per week, telephonic review and participate in interdisciplinary case reviews
- Escalate complex or ambiguous cases to the Vivant Health Medical Director or Physician Reviewer
- Ensure complete, accurate, and compliant documentation in alignment with CMS and Vivant Health standards
- Monitor daily inpatient census for Vivant Health–managed members across contracted hospitals
- Support discharge planning and identify post-acute needs including SNF, rehab, home health, or DME
- Communicate avoidable days, delays in care, and readmission risks to UM leadership
- Participate in audit readiness, quality improvement projects, and performance reporting
- Educate providers and facilities on Medicare UM criteria and Vivant Health documentation standards
- Performs related duties consistent with the scope and intent of the position.
- Regular attendance.
- Travel as required.
- Maintain professional demeanor and uphold Vivant Health values.
- Adhere to all departmental performance metrics (turnaround times, quality standards, productivity).
- Attend educational sessions and training to stay current with Medicare UM requirements and policies.
- Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
- Participate in interdisciplinary team meetings and represent the UM department effectively.
- Maintain IPA, Health Plan compliance standards.
- Enforces Company policies and safety procedures.
- 3+ years of inpatient hospital nursing experience (e.g., med-surg, telemetry, ICU)
- Familiarity with CMS inpatient criteria, including the Two-Midnight Rule
- Proficiency in Microsoft Office and electronic medical record (EMR) systems
- Previous experience with IPA, MSO, or delegated managed care environments preferred.
- Working knowledge of EZ-CAP, EZ-Net, InterQual, and MCG preferred.
- Certified Case Manager (CCM), CPUR, or CPHM credential preferred.
classification and length of employment. Benefits are subject to change and may be
subject to specific elections, plan, or program terms. If eligible, the benefits
available for this temporary role may include the following:
- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)