Job Description

Utilization Management RN - Part time/48 hours

SUMMARY: The Utilization Management Nurse supports the case management department by by providing a variety of utilization management functions including but not limited to daily screening of patient admission relative to specified criteria, active involvement in denial management, acting as a resource to staff regarding clinical criteria, communication with payors to address concerns and other duties as assigned. The Utilization Management Nurse will work collaboratively with the Utilization Nurse Program Coordinator to ensure compliance with regulatory, organizational and department requirements. The Utilization Review Nurse will receive direction from the Utilization Review Program Coordinator for daily and long term tasks and projects.

POSITIONREQUIREMENTS: A) a graduate from an accredited nursing program. BSN or 4year-degree in related field strongly preferred; B) an active CaliforniaRegistered Nurse licensure (RN); C) Minimum 3 years full time RN experience inan acute care hospital setting, pediatric experience and experience in casemanagement and/or utilization Review strongly preferred.

Additionalrequired skills: A) Knowledge of Utilization Management and private and publicpayer reimbursement practices and procedures; B) Excellent organizational andcommunication skills with ability to work with a variety of health careprofessionals; C) ability to work independently; D) Proficient in workprocessing, spreadsheets and database software.

POSITION DETAILS: Part Time, 48 hours per pay period, 1100-1930 shift, must be available for shifts every other weekend.


Application Instructions

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