RN Central Utilization Review Specialist - Hybrid Schedule

Universal Health Services; Temecula (CA); On-site; USD 90,000 - 115,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401(k) with company match

Tuition reimbursement

SoFi student loan refinancing

Career development opportunities

Job summary

Southwest Healthcare's Regional office in Temecula, CA is hiring a Full-Time RN Central Utilization Review Nurse. You will plan, coordinate, and manage patient needs during hospitalization and across the continuum of care, conducting reviews for medical necessity and collaborating with providers to apply guidelines.

The role involves working with payer communications, ensuring UR compliance, and may shift to a hybrid schedule after 90 days. Weekend and holiday coverage is required.

Qualifications

• Associates degree in Nursing or graduate of a Vocational Nursing school.
• Two (2) years of clinical experience in an acute care hospital with (1) year in case management.
• Current California RN license.

Responsibilities

• Conduct admission and continued stay reviews to ensure medical necessity of level of care.
• Review medical records for accurate placement orders and reconcile variances with providers.
• Collaborate with attending and specialty providers to apply evidence-based guidelines for status decisions.
• Coordinate with Patient Access to ensure correct payer source and communication.
• Ensure compliance with UR practices as required by payers and regulators.
• Hybrid schedule may be considered after 90 days of employment.
• Available to work weekends and holidays.

Skills

Leadership

Organization

Communication

Interpersonal skills

PC proficiency

Interqual guidelines

Education

Associate degree in Nursing

Vocational Nursing training

Tools

PC applications

Job description

Southwest Healthcare's Regional office in Temecula, CA is hiring a Full-Time RN Central Utilization Review Nurse. You will plan, coordinate, and manage patient needs during hospitalization and across the continuum of care, conducting reviews for medical necessity and collaborating with providers to apply guidelines.

The role involves working with payer communications, ensuring UR compliance, and may shift to a hybrid schedule after 90 days. Weekend and holiday coverage is required.