Rn Utilization Review Nurse

Job Summary:

The Utilization Review Nurse is responsible for evaluating and managing the utilization of healthcare services to ensure appropriate, effective, and efficient patient care. This role involves reviewing patient records, coordinating with healthcare providers, and ensuring compliance with regulatory and organizational standards. The nurse will work closely with interdisciplinary teams to facilitate optimal care management and resource utilization. An active California nursing license, BLS, and ACLS certifications are required, along with experience in Utilization Management.

• Conduct utilization reviews of patient records to assess medical necessity and appropriateness of care.
• Collaborate with healthcare providers and interdisciplinary teams to coordinate patient care and discharge planning.
• Ensure compliance with regulatory requirements and organizational policies related to utilization management.
• Document findings and communicate recommendations effectively to stakeholders.
• Participate in case management activities and utilization review meetings.
• Maintain up-to-date knowledge of clinical guidelines and healthcare regulations.

• Active Registered Nurse license in the state of California.
• BLS (Basic Life Support) certification.
• ACLS (Advanced Cardiovascular Life Support) certification.
• Proof of negative TB screen within the past 12 months.
• Minimum of 3 years experience in Utilization Management or related nursing field.
• Strong clinical assessment and case management skills.
• Excellent communication and collaboration abilities.

• Experience working in hospital or acute care settings.
• Familiarity with utilization review software and electronic medical records systems.

• Must be available to work five 8-hour shifts per week, totaling 40 hours.
• Position is permanent staff with temp-to-perm hire preference; no long-term contract desired.
• Housing recommendations provided for areas within a 30-mile radius of the hospital.

• Five 8-hour shifts per week, totaling 40 hours.
• Shift schedule determined by the facility; typically daytime hours.