Utilization Management RN, CHOC Health Alliance

Rady Children's Hospital-San Diego; Orange (CA); Sur place; USD 97 000 - 151 000; Plein temps

Résumé du poste

CHOC is seeking a Utilization Management Registered Nurse to coordinate benefit management and promote high-quality, cost-effective pediatric care inOrange, California. The UM RN will work with the Medical Director and UM team, applying clinical judgment to ensure medical necessity and regulatory compliance.

The role requires strong communication, critical thinking, and collaboration, with a focus on accuracy, efficiency, and patient-centered outcomes in a dynamic hospital setting.

Qualifications

• Minimum of two years of pediatric nursing experience.
• BSN degree required.
• California RN license required.

Responsabilités

• Coordinate benefit management and review requests for medical necessity and adherence to regulatory guidelines.
• Collaborate with Medical Director and UM team to ensure appropriate care and cost effectiveness.

Connaissances

English communication

Critical thinking

Multitasking

Organization

Under pressure

Problem solving

Attention to detail

Independent work

Team collaboration

Memory recall

Formation

BSN

Outils

Cerner

MCG

EZ-Cap

Microsoft Office

Description du poste

Work Location

Orange, California

Work Shift

Day – 08hrs (United States of America)

Why CHOC?

At CHOC, we strive to be the leading destination of children’s health by providing exceptional and innovative care. We are responsible for the overall health of our community’s pediatric population in our hospitals, clinics, and practices. And because of our breadth of care, your career at CHOC can be as diverse and fulfilling as you determine. CHOC’s compensation structure, benefits offerings, and career development programs are geared to helping you achieve your professional and personal goals.

Job Summary

The Utilization Management (UM) RN utilizes independent clinical judgement and expertise to coordinate benefit management, and promote quality, cost- effective health care. The UM RN works both independently, while also collaborating with the Medical Director and entire UM team, to ensure requests are reviewed with consideration to medical necessity, appropriateness of requested services and compliance with regulatory guidelines. This position requires attention to detail, outstanding organizational skills and efficient work habits.

Pay Range

Minimum $96,512.00 Midpoint $120,640.00 Maximum $150,800.00

Rate of pay is determined by various factors, including but not limited to knowledge, skills, competencies, experience, education, as well as position requirements.

Experience:

• Required: Minimum of two (2) years of pediatric experience
• Preferred: One or more years of Utilization or Case Management experience

Education:

• Required: Bachelor of Science in Nursing degree (BSN)

Specialized Skills:

• Required: Able to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision.
• Preferred: Experience with Cerner, MCG or other evidence-based clinical guidelines; EZ-Cap and/or Microsoft Office

Licensure:

• Required: California Registered Nurse license.
• Preferred: Basic Life Support (BLS) certification.

Work Environments - Functional Demand:

Light - Moderate energy level Lift and carry 25-35 lbs. Push/pull 50-100 lbs. (ie. empty bed, stretcher).

Physical Activity Requirements:

Bending, Carry Objects, Climbing, Keyboard use/repetitive motion, Pinching/fine motor activities, Push/Pull, Reaching forward, Reaching overhead, Sitting, Squat/kneel/crawl (Squad & Knee), Standing, Talk or hear, Taste or smell, Twisting, Walking, Wrist position deviation

Physical Activity Lifting

Lifting (Floor to waist level) - Occasional 0-35%, Lifting (Waist level and above) - Occasional 0-35%

Sensory Requirements:

Color Discrimination, Depth Perception, Far Vision, Hearing, Near Vision

Environment Requirements:

Airborn Communicable Disease, Bloodborne Pathogens, Chemical, Dust Particular Matter, Extreme Noise Levels, Extreme Temperatures, Radiation, Uneven Surfaces or Elevations

Non-Discrimination Statement:

CHOC does not discriminate on the basis of age, race, color, religion, national origin, ancestry, marital status, genetic information, disability, sex, gender (including pregnancy, breastfeeding, childbirth, lactation or related medical conditions), gender identity or expression, medical condition, sexual orientation, veteran status, military or uniformed service member status, or other protected characteristics in accordance with state and federal laws.

We encourage individuals from all backgrounds to apply for positions at CHOC, even if your experience doesn’t align perfectly with the listed qualifications for a particular role, as your unique experience may be a great addition to our culture for another one of our opportunities.

If you desire support or accommodations throughout the Talent Acquisition process, please inform your Talent Acquisition Partner.