RN Utilization Review Nurse

About This Role

This full-time RN Central Utilization Review Nurse position is based in the Southwest Healthcare Regional office in Temecula, CA. The role involves carrying out utilization management functions by planning, coordinating, and managing patient needs during hospitalization and throughout the continuum of care. A hybrid schedule may be considered after 90 days of employment, but availability to work weekends and holidays is required.

Responsibilities

• Conduct admission and continued stay reviews per guidelines to ensure medical necessity of level of care and hospitalization for multiple entities
• Review medical records for the presence of accurate placement orders and reconcile variances with patient providers
• Work collaboratively with attending providers, specialty providers, and physician advisors to ensure the application of evidence-based guidelines for determining appropriate status
• Collaborate with the Patient Access team to ensure correct payer source for hospitalization and communication
• Ensure compliance of utilization review practices as required by payers, external regulatory agencies, and the organization

Requirements

• Associates degree in Nursing or Graduate of a Vocational Nursing school
• Two (2) years of clinical experience in an acute care hospital setting with one (1) year in an inpatient or outpatient case management setting
• Current license as an RN in the State of California
• Demonstrates knowledge and ensures compliance with the Nurse Practice Act, The Joint Commission and Title 22 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
• Knowledge of PC and applications
• Capable of resolving escalated issues arising from operations and requiring coordination with others
• Knowledgeable in Interqual guidelines

Benefits

• Challenging and rewarding work environment
• Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(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 300+ Subsidiaries

About the Company

Southwest Healthcare is a comprehensive network of care with convenient hospital and ambulatory care/outpatient locations serving the Southern California community. With over 6,000 passionate providers and healthcare employees, its shared goal is to provide convenient access to a wide range of healthcare services. Southwest Healthcare is comprised of five acute care hospitals and several non-hospital access points, including Corona Regional Medical Center, Palmdale Regional Medical Center, Southwest Healthcare Rancho Springs Hospital, Southwest Healthcare Inland Valley Hospital and Temecula Valley Hospital, Temecula Valley Day Surgery, A+ Urgent Care Centers, and Riverside Medical Clinics. Headquartered in King of Prussia, PA, Universal Health Services, Inc. (NYSE: UHS) is one of the nation’s largest and most respected providers of hospital and healthcare services, founded in 1979.