Licensed Vocational Nurse (LVN) - Utilization Review

This position may qualify for a sign-on bonus



The individual in this position is responsible to facilitate effective resource coordination to help patients achieve 

optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and 

right to self-determination. The individual in this position has overall responsibility for ensuring that care is 

provided at the appropriate level of care based on medical necessity. This position integrates national standards 

for case management scope of services including:

• Utilization Management services supporting medical necessity and denial prevention 

• Coordination with payers to authorize appropriate level of care and length of stay for medically necessary 

services required for the patient

• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy 

• Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered 

services and administration of benefits

The individual’s responsibilities include the following activities: a) accurate medical necessity screening and 

submission for Physician Advisor review, b) securing and documenting authorization for services from payers, c) 

managing concurrent disputes, d) collaborating with payers, physicians, office staff and ancillary departments, e) 

timely, complete and concise documentation in the Tenet Case Management documentation system, f) 

maintenance of accurate patient demographic and insurance information, g) identification and documentation of 

potentially avoidable days, h) identification and reporting over and underutilization, i) and other duties as 

assigned

MINIMUM EDUCATION: Graduate of an accredited School of Nursing 
PREFERRED EDUCATION: Associates in Nursing 
MINIMUM EXPERIENCE: 2 years acute hospital or behavioral health patient care experience with at least 
1 year utilization review in an acute hospital or commercial/managed care payer setting.
PREFERRED EXPERIENCE: 1 year hospital acute or behavioral health case management experience.
REQUIRED CERTIFICATIONS/LICENSURE: Must be currently licensed, certified or registered to practice 
profession as required by law or regulation in state of practice or policy. Active LVN/LPN license for 
state(s) covered.
PREFERRED CERTIFICATIONS/LICENSURE: Accredited Case Management (ACM)

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