Utilization Review Licensed Practical Nurse
Company: Hines & Associates Inc
Location: Rockford
Posted on: July 1, 2025
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Job Description:
Description: LPNs – are you looking for a change? Want to work
no nights, no weekends, and no holidays? Be able to work from home
50% of the time once trained? Check out Hines & Associates! ABOUT
US: Hines is a nationwide, independent leader in personalized
managed health care, focused on what's important to
you—comprehensive services with the program excellence and cost
containment that you demand. Hines & Associates, Inc.'s reputation
as an industry leader is founded on over three decades of
innovative and professional health care excellence. Serving all
aspects of the industry, Hines is committed to conserving health
care dollars while ensuring quality care through effective programs
and personalized service. WHAT WE OFFER: - Competitive salary and
benefits, including medical, dental, vision, long-term care,
short-term disability, long-term disability, company paid and
voluntary life insurance. Critical Illness, accident insurance and
flexible spending also available! - 401k plan with company match,
fully vested after 1 year. - No weekends and nights! - Paid
Holidays - Work-life balance. - Remote/hybrid setting (once
trained) ROLE DESCRIPTION: This individual will utilize clinical
knowledge and communication skills to obtain patient specific
information regarding patient condition and proposed treatments and
procedures to determine if illness and/or proposed services meet
acceptable criteria sets and acceptable nursing practice guidelines
for outpatient treatment or inpatient confinement. This individual
will certify treatment for confinement when criteria and/or
practice guidelines are met, in accordance with the health benefit
plan, disability, workers compensation regulations and state and
federal regulations. If these conditions do not appear to be met,
this individual will defer decision to a second level reviewer.
This individual interfaces with case managers and disease
management nurses on active cases involved in other Hines'
programs. This is a Monday through Friday position, 9:30 AM to 6:00
PM. RESPONSIBILITIES AND PERFORMANCE: - Completes first level
reviews within the scope of practice relevant to the clinical
area(s) addressed in the initial clinical review. General
Medical-Surgical nursing is sufficient to be relevant to the
clinical areas addressed in most initial clinical reviews. . -
Demonstrates ability to assess a patient's current medical status,
including complications and untoward events, which may require
additional intervention. Provides certification of medical,
disability and workers compensation cases. - Demonstrates a
thorough understanding of criteria sets and their limitations
including when a second level review is required. - Evaluates
appropriateness of current plan of care. - Assesses aftercare
needs, implements discharge planning and/or case management
referral in a timely manner. - Maintains knowledge of current
advances and trends in medical care. - Demonstrates knowledge of
URAC guidelines, Hines policies and procedures, and standards of
practice and their revisions. Able to attain and maintain the
minimal quality assurance performance standards. - Demonstrates
assertiveness in completion of precertification and concurrent
review within the guidelines of URAC, disability, workers
compensation regulations, and state and federal requirements and
according to the Hines policies and procedures. - Performs onsite
evaluations as needed or requested. - Additional responsibilities
as assigned. COMMUNICATION: - Communicates with hospital staff,
physicians, other providers and Hines customer contacts in a
competent, calm, effective and professional manner. - Effectively
communicates the need to refer to a higher-level review for
questionable plans of treatment. - Provides written documentation
concerning the clinical information obtained regarding the
patient's status, benefit and claim concerns, and validation of
criteria. - Communicates knowledge of policies and procedures, URAC
guidelines, disability and workers compensation regulations, state
and federal requirements, and standards of practice. PERSONAL AND
PROFESSIONAL: - Participates in self-evaluation by identifying
areas of strength and limitations and offers and accepts
constructive criticism. - Creative and assertive. - All First Level
Reviewers are required to sign and honor a confidentiality
statement at the time of hire and annually at the time of
performance reviews. PM21 Requirements: QUALIFICATIONS: 1. Licensed
Practical Nurse with valid, unrestricted, current nursing license
in the state or territory of the United States where employed. LPN
2. Successful completion of UR nurse orientation program. 3.
Minimum of 3 years recent acute clinical practice required; 5 years
preferred. 4. Managed care, disability or workers compensation
experience helpful but not mandatory. 5. Customer service oriented.
*Hines welcomes diversity and as an equal opportunity employer all
qualified applicants will be considered regardless of race,
religion, color, national origin, sex, age, sexual orientation,
gender identity, disability or protected veteran status.*
Compensation details: 22.95-25.75 Hourly Wage
PIb2145960bb61-37156-35923106
Keywords: Hines & Associates Inc, Hammond , Utilization Review Licensed Practical Nurse, Healthcare , Rockford, Indiana
