RN Central Utilization Review - Hybrid Schedule

Southwest Healthcare; Temecula (CA); On-site; USD 95,000 - 125,000; Full time

Benefits offered by this job

Competitive Compensation & Generous PT

Excellent Medical, Dental, Vision

401(K) with company match

Job summary

The Southwest Healthcare Regional office in Temecula, CA is seeking a Full-Time RN Central Utilization Review Nurse to coordinate patient needs during hospitalization and across the continuum of care.

You will conduct admission and continued stay reviews, verify medical necessity, and collaborate with providers to apply evidence-based guidelines, with weekend/holiday availability and potential hybrid scheduling after 90 days.

Qualifications

• Associates degree in Nursing or Graduate of a Vocational Nursing school required.
• Two years of clinical experience in an acute care hospital with one year in case management.

Responsibilities

• Carries out utilization management functions by planning, coordinating and managing patient needs during hospitalization and continuum of care.
• Conducts admission and continued stay reviews to ensure medical necessity of level of care.
• Reviews medical records and reconciles variances with patient providers.
• Collaborates with attending and specialty providers to apply evidence-based guidelines.
• Works with Patient Access to ensure correct payer source and communication.
• Ensures compliance with payers, regulators and organization; may work a hybrid schedule after 90 days.
• Must be available to work weekends and holidays.

Skills

RN

Nursing

Case management

Interqual guidelines

Communication

Education

Associate degree in Nursing (ADN) or Vocational Nursing diploma

Tools

PC applications

Job description

The Southwest Healthcare Regional office in Temecula, CA is seeking a Full-Time RN Central Utilization Review Nurse to coordinate patient needs during hospitalization and across the continuum of care.

You will conduct admission and continued stay reviews, verify medical necessity, and collaborate with providers to apply evidence-based guidelines, with weekend/holiday availability and potential hybrid scheduling after 90 days.