LVN, Lead Medication Referral Nurse

LVN, Lead Medication Referral Nurse – Desert Oasis Healthcare

The lead Medication Referral Nurse, Utilization Management and Quality Monitoring Specialist is responsible for overseeing daily operations and providing training and support to Medication Referral Coordinators. This role delivers high‑level, complex referral support and coordination to the manager, serves as a liaison between the Referral Department, requesting providers, and the Medication Referral team, and acts as a subject‑matter expert to staff.

The position also assists with clinical staff development, health‑plan audits, and quality improvement reports as needed.

• Current California LVN license required.
• Minimum of 3 years of healthcare experience.
• Minimum of 2 years of experience in Quality, Utilization Review or Utilization Management with knowledge of Medicare and Managed Care rules.
• Basic computer skills; familiarity with Microsoft Word and Excel. Experience with EZ‑Cap, Q Auth, and Next‑Gen is preferred.
• Exceptional communication, detail‑oriented, critical‑thinking, and problem‑solving skills; excellent customer service and telephone etiquette.
• Bilingual preferred but not required.
• Ability to manage time effectively and reprioritize tasks to meet deadlines.
• Position may be full or hybrid telecommuting at the discretion of management.

• Facilitate open communication during team meetings and model collaborative problem‑solving.
• Provide guidance and serve as a resource to Referral Coordinators; assist with coverage and training as needed.
• Support leadership by guiding referral staff in daily operations, coordinating staffing coverage, and offering input for timely performance reviews.
• Act as the primary resource for infusion/injection related questions pertaining to medication referral process, contracts, and benefits provider/member inquiries.
• Assist in developing education material and training new employees.
• Participate in continuous quality improvement activities and audit evaluations.
• Track, prioritize, and respond to daily departmental requests to ensure timely resolution of UM/health‑plan audits.
• Assist management with developing policy and procedures as required.
• Serve as liaison with other departments to troubleshoot and resolve referral issues, escalating complex matters when necessary.
• Track referral turnaround times and accuracy, providing oversight to minimize processing errors in accordance with regulations and protocols.
• Support leadership in maintaining a positive work environment by addressing employee concerns and facilitating conflict resolution.
• Perform other duties assigned.
• Be knowledgeable, accountable, and demonstrate appropriate body language and tone of voice.

• Sitting – Approximately 70% of day.
• Standing – Approximately 15% of day.
• Walking – Approximately 15% of day.
• Lifting 0‑20 lbs (charts, supplies) – Approximately 10% of day.
• Bending – Approximately >10% of day; kneeling