Registered Nurse (RN), Utilization Management, Full Time, Days Alternating Weekends

Los Angeles, CA - USA

Monthly Salary: USD 53 - 79

Posted on: 27 days ago

Vacancies: 1 Vacancy

Job Summary

The Utilization Management (UM) RN performs utilization review activities including but not limited to precertification ensures appropriate level of care and status (Inpatient Outpatient and Observation) throughout admission and performs concurrent reviews/retrospective reviews according to guidelines. Determines the medical necessity of requests by performing first level reviews. The UM nurse ensures a process that is efficient for providing care ensuring timely and appropriate levels of care for the incoming patients. UM RN is responsible for preparing cases for Physician Advisor for 2^nd level review.

PIH Health is a nonprofit regional healthcare network that serves approximately 3 million residents in the Los Angeles County Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital PIH Health Good Samaritan Hospital PIH Health Whittier Hospital 37 outpatient medical office buildings a multispecialty medical (physician) group home healthcare services and hospice care as well as heart cancer digestive health orthopedics womens health urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nations top hospital systems for best practices cutting-edge advancements quality of care and healthcare technology. For more information visit or follow us on Facebook Twitter or Instagram.

Required Skills

Excellent verbal and written communication skills
Ability to follow chain of command.
Highly developed ability to multi-task and maintain focus
Proactive can-do approach and desire to build positive working relationships through collaborative
problem-solving
Self-motivated and results oriented. Must be able to demonstrate sound decision making flexibility
and prioritization skills with minimal supervision.
Strong organizational skills
Basic computer skills: Word Excel PowerPoint Outlook. Able to utilize multiple electronic systems. Type 50 WPM.
Ability to apply appropriate UM criteria.

Required Skills

Excellent verbal and written communication skills
Ability to follow chain of command.
Highly developed ability to multi-task and maintain focus
Proactive can-do approach and desire to build positive working relationships through collaborative
problem-solving
Self-motivated and results oriented. Must be able to demonstrate sound decision making flexibility
and prioritization skills with minimal supervision.
Strong organizational skills
Basic computer skills: Word Excel PowerPoint Outlook. Able to utilize multiple electronic systems. Type 50 WPM.
Ability to apply appropriate UM criteria.