Utilization Management Registered Nurse

LE01 Valley Children's Hospital; United States; On-site; USD 78,922 - 112,577; Full time

Job summary

LE01 Valley Children's Hospital is looking for a Utilization Management Nurse to support the case management department. Responsibilities include daily screening of patient admissions, denial management, and communication with payors.

The ideal candidate should have an Associate's Degree in Nursing, an RN License, and at least three years of acute care experience. Compensation ranges from $57.29 to $81.72 per hour, with a work schedule of 36 hours per week.

Qualifications

• Minimum three years of full-time equivalent RN experience in an acute care hospital.
• Registered Nurse (RN) License required.
• Pediatric experience preferred.

Responsibilities

• Daily screening of patient admission relative to specified criteria.
• Active involvement in denial management.
• Act as a resource to staff regarding clinical criteria.
• Communicate with payors to address concerns.
• Provide support to the Utilization Nurse Program Coordinator.

Skills

Knowledge of utilization management regulations

Excellent organizational and communication skills

Ability to work independently

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing or related field

Tools

Proficiency with word processing software

Proficiency with spreadsheets

Proficiency with database software

Job description

Job Summary

The Utilization Management Nurse supports the case management department by providing utilization management functions such as daily screening of patient admission relative to specified criteria, active involvement in denial management, acting as a resource to staff regarding clinical criteria, communication with payors, and other duties as assigned.

Responsibilities

• Daily screening of patient admission relative to specified criteria
• Active involvement in denial management
• Act as a resource to staff regarding clinical criteria
• Communicate with payors to address concerns
• Provide support to the Utilization Nurse Program Coordinator to ensure compliance with regulatory, organizational and department requirements
• Perform additional duties as assigned

Qualifications

• Education
  • Associate's Degree in Nursing (required)
  • Bachelor's Degree in Nursing or related field (preferred)
• Licenses and Certifications
  • Registered Nurse (RN) License – California Board of Registered Nursing (required)
• Experience
  • Minimum three (3) years of full-time equivalent RN experience in an acute care hospital (required)
  • Pediatric experience, case management and/or utilization review (preferred)
• Knowledge & Skills
  • Knowledge of utilization management regulations
  • Knowledge of private and public payer reimbursement practices and procedures
  • Excellent organizational and communication skills
  • Ability to work with a variety of health care professionals
  • Ability to work independently
• Computer Skills
  • Proficiency with word processing, spreadsheets and database software

Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Compensation & Work Hours

Compensation Range: $57.29 - $81.72 per hour

Workshift: Day (United States)

Position Exempt: No

FTE: 90%

Scheduled Weekly Hours: 36

Daily Hours: 8

Location

United States of America