Utilization Review Nurse (RN)

Madera Community Hospital; Madera (CA); On-site; USD 75,000 - 95,000; Full time

Job summary

Madera Community Hospital in California is seeking a Utilization Review Nurse to assess, plan, implement, and evaluate patient needs for discharge and utilization review processes. The role involves working closely with patients, families, physicians, and nursing staff to ensure seamless discharge planning.

Candidates must possess at least 1-3 years of relevant health-care experience, a valid California RN license, and the ability to provide exceptional customer service in a collaborative environment.

Qualifications

• Minimum of 1-3 years of related acute health-care experience.
• Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.
• Ability to maintain collaborative working relationships.
• Ability to plan and prioritize work with frequent interruptions.
• Ability to provide exceptional customer service.

Responsibilities

• Assess, plan, implement and evaluate patients' needs for discharge planning.
• Coordinate discharge planning with physicians and nursing staff.
• Perform utilization review procedures including knowledge of insurance criteria.

Skills

Customer service

Verbal communication

Written communication

Collaboration

Prioritization

Education

Completion of an accredited nursing program

Current California Board of Nursing Registered Nurse License

Current American Heart Association BCLS certificate

ACLS certificate preferred

CCM in Case Management preferred

Tools

Hospital information technology applications

Job description

Madera Community Hospital is a General Acute Care, private, not‑for‑profit facility located in Central California, dedicated to improving and maintaining the health and wellness of residents throughout the Central Valley. We are committed to identifying and serving our community’s needs with compassion, concern, care and safety for every patient.

Position Summary

The Utilization Review Nurse assesses, plans, implements and evaluates the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO or private insurance coverage for their stay at various units. Discharge planning is coordinated with physicians, nursing staff, patients and families who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid, HMO or private insurers.

Qualifications

• Minimum of 1‑3 years of related acute health‑care experience and completion of an accredited nursing program.
• Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.
• Ability to maintain collaborative working relationships to ensure a positive and productive work environment.
• Ability to plan and prioritize work with frequent interruptions.
• Ability to provide exceptional customer service.
• Effective verbal and written communication skills.
• Knowledge and proficiency of hospital information technology applications.
• Current California Board of Nursing Registered Nurse License.
• Current American Heart Association BCLS certificate.
• ACLS certificate preferred.
• CCM in Case Management Preferred.

Madera Community Hospital provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.