Utilization Review Nurse - Full Time

Stand Together Ventures Lab; Bakersfield (CA); On-site; USD 85,000 - 110,000; Full time

Job summary

Stand Together Ventures Lab is seeking a Utilization Review Nurse in Bakersfield, CA to implement hospital utilization review and discharge planning programs.

The role involves obtaining and evaluating medical records, coordinating with hospital services and external agencies, and ensuring reimbursement compliance with regulations. Strong communication with providers and data analysis for reporting are essential.

Qualifications

• Valid California RN license with two years of acute care or utilization/discharge planning experience.
• Knowledge of payor documentation, healthcare regulations, patient care processes, and hospital operations.
• Ability to evaluate medical records, communicate effectively with providers, and analyze data for reporting.

Responsibilities

• Obtain and evaluate medical records to assess inpatient admissions.
• Conduct ongoing care reviews and develop discharge plans.
• Coordinate with hospital services and external agencies; ensure reimbursement and regulatory compliance.
• Review and approve surgical schedules; manage pay source issues; educate providers on documentation requirements to maximize reimbursement.

Skills

Clinical assessment

Regulatory knowledge

Communication

Collaboration

BLS certification

Education

California RN license

Job description

Role:

Utilization Review Nurse, responsible for implementing hospital utilization review and discharge planning programs.

Key Duties:

Obtain and evaluate medical records to assess inpatient admissions, conduct ongoing care reviews, develop discharge plans, coordinate with hospital services and external agencies, and ensure appropriate reimbursement and compliance with regulations. Review and approve surgical schedules, manage pay source issues, and educate providers on documentation requirements to maximize reimbursement.

Qualifications:

Valid California RN license with two years of acute care or utilization/discharge planning experience. Knowledge of payor documentation, healthcare regulations, patient care processes, and hospital operations. Ability to evaluate medical records, communicate effectively with providers, and analyze data for reporting.

Skills:

Strong clinical assessment, regulatory knowledge, communication, and collaboration skills. Must maintain BLS certification and adhere to professional standards.

Additional:

May be required to undergo background checks and possess a valid California driver’s license if driving is necessary.