RN Utilization Review Nurse — Impact & Compliance

Dignity Health; Long Beach (CA); Sur place; USD 81 000 - 101 000; Plein temps

Résumé du poste

Dignity Health - St. Mary Medical Center in Long Beach, CA seeks a Utilization Review Nurse to safeguard efficient, high-quality patient care. You will review records, authorize services, and prep cases for physician review with UM teams, ensuring alignment with criteria and regulatory standards.

Ideal candidates have strong UM knowledge, excellent analytic and organizational skills, and the ability to communicate empathetically with stakeholders. California RN licensure is required.

Qualifications

• California RN license required or in process.
• Two years acute hospital experience or MSN in lieu of one year.
• Familiarity with utilization review guidelines and CMS requirements.
• Strong analytical and organizational abilities.

Responsabilités

• Review medical records for admission and continued stay per guidelines.
• Authorize services and prepare cases for physician review with UM teams.
• Monitor care for appropriateness, quality, and cost-effectiveness.
• Communicate review outcomes timely with physicians, payers, and care coordinators.
• Collaborate with RN Care Coordinators to ensure progression of care.
• Engage second level physician reviewers when needed.

Connaissances

RN license

Critical thinking

Communication

Team collaboration

Regulatory knowledge

Analytical skills

Formation

BSN preferred

Outils

MCG/InterQual

Description du poste

Dignity Health - St. Mary Medical Center in Long Beach, CA seeks a Utilization Review Nurse to safeguard efficient, high-quality patient care. You will review records, authorize services, and prep cases for physician review with UM teams, ensuring alignment with criteria and regulatory standards.

Ideal candidates have strong UM knowledge, excellent analytic and organizational skills, and the ability to communicate empathetically with stakeholders. California RN licensure is required.