Utilization Management Registered Nurse

The Utilization Management Nurse supports the case management department by providing a variety of utilization management functions including but not limited to daily screening of patient admission relative to specified criteria active involvement in denial management acting as a resource to staff regarding clinical criteria communication with payors to address concerns and other duties as assigned. The Utilization Management Nurse will work collaboratively with the Utilization Nurse Program Coordinator to ensure compliance with regulatory organizational and department requirements. The Utilization Review Nurse will receive direction from the Utilization Review Program Coordinator for daily and long term tasks and projects.

Qualifications:

Education

• Associates Degree Nursing (required)
• Bachelors Degree Nursing or related field (preferred)

Licenses and Certifications

• RN - Registered Nurse License - CA-BRN - California Board of Registered Nursing (required)

Work Experience

• Minimum three (3) years Full time equivalent RN experience in an acute care hospital. (required)
• Pediatric experience and experience in Case Management and/or Utilization Review. (preferred)

Skills and Abilities

• Knowledge of UM regulations.
  Knowledge of private and public payer reimbursement practices and procedures.
  Excellent organizational and communication skills and ability to work with a variety of health care professionals.
  Ability to work independently.
• Computer Skills Proficiency with word processing spreadsheets and database software.

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Compensation Range:

$57.29 - $81.72

Workshift:

Day (United States of America)

Position Exempt:

No

FTE %:

90

Scheduled Weekly Hours:

36

Daily Hours:

8

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