Utilization Review Nurse - Full-Time

UHS•Temecula, CA

45d•Hybrid

About The Position

The Southwest Healthcare Regional office in Temecula, CA is seeking a Full-Time Central Utilization Review Nurse who will be responsible for carrying out utilization management functions by planning, coordinating, and managing patient needs during hospitalization and throughout the continuum of care. Duties include but not limited to: Conducts admission and continued stay reviews per guidelines to ensure medical necessity of level of care and hospitalization for multiple entities. Reviews medical record for presence of accurate placement orders reconciles variances with patient providers. Works collaboratively with attending providers, specialty providers, and physician advisors to ensure application of evidence-based guidelines for determining appropriate status. Collaborates with Patient Access team to ensure correct payer source for hospitalization and communication. Ensures compliance of utilization review practices as required by payers, external regulatory agencies, and organization. Hybrid schedule may be considered after 90 days of employment. Must be available to work weekends and holidays.

Requirements

Associates degree in Nursing or Graduate of a Vocational Nursing school required.
Two (2) years of clinical experience in an acute care hospital setting with (1) year in of inpatient Care Management and/or Utilization Review experience required.
Current license as a RN in the State of California required.
Demonstrates knowledge and ensures compliance with the Nurse Practice Act, The Joint Commission and Title 22 standards and guidelines.
Demonstrates compliance with hospital policies and procedures at all times.
Demonstrates strong leadership, organization, communication and interpersonal skills.
Demonstrates ability to relate to clinical personnel and medical staff, as well as ability to interact well with the public.
Must have knowledge of PC and applications.
Capable of resolving escalated issues arising from operations and requiring coordination with other
Knowledgeable in Interqual guidelines.

Responsibilities

Conducts admission and continued stay reviews per guidelines to ensure medical necessity of level of care and hospitalization for multiple entities.
Reviews medical record for presence of accurate placement orders reconciles variances with patient providers.
Works collaboratively with attending providers, specialty providers, and physician advisors to ensure application of evidence-based guidelines for determining appropriate status.
Collaborates with Patient Access team to ensure correct payer source for hospitalization and communication.
Ensures compliance of utilization review practices as required by payers, external regulatory agencies, and organization.