Job Description

Utilization Review Program Coordinator - RN

SUMMARY: The Utilization Review Nurse Coordinator is accountable for oversight of the Utilization Management program at Children's Hospital, under the direction of department leadership. Under minimal supervision, the UR Nurse Coordinator reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. The position combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments, problem identification and education, the coordinator will facilitate the quality of health care delivery in the most cost effective manner. The coordinator will ensure compliance with all regulations related to Utilization Management, will develop quarterly reports for the U.M. Medical Director for presentation at PT&U committee, and will facilitate UM subcommittee meetings.

JOB REQUIREMENTS: This position requires : A) a graduate from an accredited nursing program, BSN or 4 year-degree in related field strongly preferred; B) an active California Registered Nurse licensure (RN); C) Minimum 5 years full time RN experience in an acute care hospital setting, pediatric experience and experience in case management and/or utilization Review strongly preferred. Experience to include; knowledge of UM regulations and private and public payer reimbursement practices
and procedures. Excellent organizational and communication skills and ability to work with a variety of health care professionals and ability to work independently. Proficiency with word processing, spreadsheets and database software.

POSITION DETAILS: Full Time, 80 hours per 2-week pay period, Mon-Fri, 8-hour shifts


Application Instructions

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