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

Responsibilities

Join the Southwest Healthcare Team!

About Us:

Creating Health and Harmony, Southwest Healthcare is a comprehensive network of care with convenient hospital and ambulatory care/outpatient locations here to serve the Southern California community. With over 6,000 passionate providers and healthcare employees, our shared goal is to provide convenient access to a wide range of healthcare services in a way that benefits you, your family, and the entire community.

Southwest Healthcare is comprised of five acute care hospitals and several non-hospital access points, including: Corona Regional Medical Center, Palmdale Regional Medical Center, Southwest Healthcare Rancho Springs Hospital, Southwest Healthcare Inland Valley Hospital and Temecula Valley Hospital, Temecula Valley Day Surgery, A+ Urgent Care Centers, and Riverside Medical Clinics. For more information, please visit our website at www.swhealthcaresystem.com.

Job Summary

The Southwest Healthcare Regional office in Temecula, CA is seeking a Full-Time RN 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.

Benefit Highlights

• Challenging and rewarding work environment.
• Competitive Compensation & Generous Paid Time Off.
• Excellent Medical, Dental, Vision and Prescription Drug Plans.
• 401(K) with company match and discounted stock plan.
• SoFi Student Loan Refinancing Program.
• Tuition, CEU, Certification, Licenses Reimbursement program.
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: UHS Guest Benefits

Qualifications

Experience/Training/Experience:

• 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 an inpatient or outpatient case management setting required.

Certifications/Licenses:

• Current license as a RN in the State of California required.

Other Skills and Abilities:

• 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.

About Universal Health Services

Headquartered in King of Prussia, PA, Universal Health Services, Inc. (NYSE: UHS) is one of the nation’s largest and most respected providers of hospital and healthcare services. Since our founding in 1979, UHS has grown steadily into a premier Fortune 500® corporation perennially recognized by multiple esteemed national rating entities. Through its subsidiaries, UHS operates inpatient acute care facilities, inpatient behavioral health facilities, outpatient and other facilities, nationwide virtual behavioral health services, an insurance offering, a physician network and various related services with physical locations in the U.S., Puerto Rico, Ireland and United Kingdom. www.uhs.com.

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EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.