RN Utilization Review Specialist

The County of Santa Clara; California (MO); On-site; USD 90,000 - 120,000; Full time

Job summary

The County of Santa Clara seeks an experienced Utilization Review RN to review, monitor and assess hospital service utilization in accordance with federal, state and county regulations and the Santa Clara Valley Healthcare Utilization Plan.

Under direction, the role administers Utilization Review procedures, maintains liaison with hospital staff across SCVH facilities, and supports multiple sites as needed.

Qualifications

• Current California RN certificate is required and must be attached to the application.
• Two years of recent acute care nursing experience are normally required.
• Utilization Review experience in acute care is desirable.

Responsibilities

• Monitor admissions and review justification for services.
• Certify patient stays and outpatient services as appropriate.
• Prepare documentation for payment and maintain records.
• Liaise with hospital staff and other departments.
• Ensure compliance with Utilization Review regulations and standards.
• Attend to concurrent reviews of inpatients and related duties.

Skills

RN certification

Clinical nursing

Utilization Review

Communication

Education

California RN license

Job description

The County of Santa Clara seeks an experienced Utilization Review RN to review, monitor and assess hospital service utilization in accordance with federal, state and county regulations and the Santa Clara Valley Healthcare Utilization Plan.

Under direction, the role administers Utilization Review procedures, maintains liaison with hospital staff across SCVH facilities, and supports multiple sites as needed.