Utilization Review Nurse

Job Summary:

The Utilization Review Nurse / Case Manager is responsible for evaluating patient care to ensure appropriate utilization of healthcare resources, coordinating discharge planning, and facilitating communication among patients, families, and healthcare providers. This role requires experienced nursing professionals to perform thorough case reviews, manage patient care plans, and collaborate with interdisciplinary teams to optimize patient outcomes and resource use.

• Conduct utilization reviews to assess the necessity, appropriateness, and efficiency of healthcare services.
• Coordinate discharge planning to ensure smooth transitions from hospital to home or other care settings.
• Collaborate with physicians, nurses, social workers, and other healthcare professionals to develop and implement patient care plans.
• Review patient records, insurance authorizations, and clinical documentation to support case management decisions.
• Communicate effectively with patients and families regarding care plans and discharge instructions.
• Maintain compliance with regulatory requirements and hospital policies related to utilization review and case management.
• Document case findings, decisions, and outcomes accurately and timely in the medical record system.

• Active Registered Nurse license in the state of California.
• BLS (Basic Life Support) certification.
• ACLS (Advanced Cardiovascular Life Support) certification.
• Minimum of 4 years nursing experience, preferably with case management or utilization review.
• Proof of negative TB screen within the past 12 months.
• Strong clinical assessment and critical thinking skills.
• Excellent communication and interpersonal skills.

• Experience in discharge planning and care coordination.
• Familiarity with healthcare insurance processes and authorization procedures.
• Knowledge of hospital and community healthcare resources within Northern California.

• Position is temp-to-perm with preference for candidates seeking permanent placement.
• Must be able to work within a 30-mile radius of the hospital, including Arcata, Eureka, McKinleyville, Blue Lake, Samoa, and Fortuna.
• Housing recommendations provided for temporary accommodations.
• Work environment includes hospital and community healthcare settings.

• Five 8-hour shifts per week, totaling 40 hours guaranteed.
• Day shift schedule.