Hybrid RN — Central Utilization Review Nurse

Southwest-Healthcare-System; Temecula (CA); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical Plan

Dental Plan

Vision Plan

Prescription Drug Plan

401K with match

Stock Plan Discount

Student Loan Refinancing

Tuition Reimbursement

CEU/ Certification Reimbursement

Career Development

Job summary

Southwest Healthcare System is seeking a Full-Time RN Central Utilization Review Nurse in Temecula, CA. Responsibilities include planning, coordinating, and managing patient needs during hospitalization and the continuum of care.

Responsibilities cover admission reviews, medical necessity, provider collaboration, payer communication, and regulatory compliance. A hybrid schedule may be considered after 90 days, with weekend and holiday availability expected.

Qualifications

• Associates degree in Nursing or Vocational Nursing graduate required.
• Two years of clinical hospital experience; one year in case management preferred.

Responsibilities

• Carry out utilization management throughout hospitalization and continuum of care.
• Conduct admission and continued stay reviews for medical necessity.
• Review medical records and reconcile placement orders with providers.
• Collaborate with attending and specialty providers to apply evidence-based guidelines.
• Coordinate with Patient Access for payer source communication.
• Ensure compliance with payers and regulatory requirements.
• Hybrid schedule may be considered after 90 days.
• Available to work weekends and holidays.

Skills

Critical thinking

Communication skills

Leadership

Interpersonal skills

PC literacy

Education

Associate degree in Nursing

Graduate of Vocational Nursing

Tools

InterQual guidelines

Job description

Southwest Healthcare System is seeking a Full-Time RN Central Utilization Review Nurse in Temecula, CA. Responsibilities include planning, coordinating, and managing patient needs during hospitalization and the continuum of care.

Responsibilities cover admission reviews, medical necessity, provider collaboration, payer communication, and regulatory compliance. A hybrid schedule may be considered after 90 days, with weekend and holiday availability expected.