Utilization Review Nurse (RN)

About This Role

This nursing role assesses, plans, implements, and evaluates the needs of patients for discharge planning and utilization review. The nurse coordinates discharge planning with physicians, nursing staff, patients, and their families, and applies knowledge of criteria for various insurance coverages.

Responsibilities

• Assess, plan, implement, and evaluate the needs of patients for discharge planning and utilization review
• Coordinate discharge planning with physicians, nursing staff, patients, and families
• Apply knowledge of criteria for Medicare, Medicaid, HMO, and private insurance coverage

Requirements

• Minimum of 1-3 years of related acute healthcare experience
• Completion of an accredited nursing program
• Working knowledge of criteria for Medicare, Medicaid, HMO, and private insurance coverage
• Ability to maintain collaborative working relationships to ensure a positive and productive work environment
• Ability to plan and prioritize work with frequent interruptions
• Ability to provide exceptional customer service
• Effective verbal and written communication skills
• Knowledge and proficiency of hospital information technology applications
• Current California Board of Nursing Registered Nurse License
• Current American Heart Association BCLS certificate

Nice to have:

• ACLS certificate
• CCM in Case Management

About the Company

Madera Community Hospital is a General Acute Care, private, not-for-profit hospital dedicated to improving and maintaining the health and wellness of residents throughout the Central Valley. It is committed to identifying and serving the community's needs with compassion, concern, care, and safety for every patient.