RN Central Utilization Review Nurse

Job Description

Responsibilities

Join the Southwest Healthcare Team!

About Us:

Creating Health and Harmony, Southwest Healthcare is a comprehensive network of care with convenient hospital and ambulatory care/outpatient locations here to serve the Southern California community. With over 6, passionate providers and healthcare employees, our shared goal is to provide convenient access to a wide range of healthcare services in a way that benefits you, your family, and the entire community.

Job Summary:

The Southwest Healthcare Regional office in Temecula, CA is seeking a Full-Time who will be responsible for carrying out utilization management functions by planning, coordinating, and managing patient needs during hospitalization and throughout the continuum of care. Duties include but not limited to:

• Conducts admission and continued stay reviews per guidelines to ensure medical necessity of level of care and hospitalization for multiple entities.
• Reviews medical record for presence of accurate placement orders reconciles variances with patient providers.
• Works collaboratively with attending providers, specialty providers, and physician advisors to ensure application of evidence-based guidelines for determining appropriate status.
• Collaborates with Patient Access team to ensure correct payer source for hospitalization and communication.
• Ensures compliance of utilization review practices as required by payers, external regulatory agencies, and organization.
• Hybrid schedule may be considered after days of employment.
• Must be available to work weekends and holidays.

Qualifications

Experience/Training/Experience:

• Associates degree in Nursing or Graduate of a Vocational Nursing school required.
• Two (2) years of clinical experience in an acute care hospital setting with (1) year in an inpatient or outpatient case management setting required.

Certifications/Licenses:

• Current license as a RN in the State of California required.

Other Skills and Abilities:

• Demonstrates knowledge and ensures compliance with the Nurse Practice Act, The Joint Commission and Title standards and guidelines.
• Demonstrates compliance with hospital policies and procedures at all times.
• Demonstrates strong leadership, organization, communication and interpersonal skills.
• Demonstrates ability to relate to clinical personnel and medical staff, as well as ability to interact well with the public.
• Must have knowledge of PC and applications.
• Capable of resolving escalated issues arising from operations and requiring coordination with other
• Knowledgeable in Interqual guidelines.

Benefit Highlights:

• Challenging and rewarding work environment.
• Competitive Compensation & Generous Paid Time Off.
• Excellent Medical, Dental, Vision and Prescription Drug Plans.
• (K) with company match and discounted stock plan.
• SoFi Student Loan Refinancing Program.
• Tuition, CEU, Certification, Licenses Reimbursement program.
• Career development opportunities within UHS and its + Subsidiaries!

Southwest Healthcare is owned and operated by subsidiaries of , a King of Prussia, PA-based company, that is one of the largest healthcare management companies in the nation.

UHS is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or e-mails. All resumes submitted by search firms to any employee at UHS; via e-mail, the Internet or in any other form and/or method without a valid written search agreement in place for the above-listed position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.