Utilization Review RN — Case Management & Care Coordination

Prime Healthcare; North Las Vegas (NV); On-site; USD 90,000 - 110,000; Full time

Job summary

North Vista Hospital, part of Prime Healthcare, seeks an experienced RN Case Manager to oversee admission and discharge planning while coordinating care for a seamless patient experience.

Responsibilities include quality resource management, promoting cost containment, and leading interdisciplinary collaboration to achieve optimal outcomes. Requires 5+ years as an RN, 1+ year case management, and solid computing skills.

Qualifications

• 5+ years' work experience as a registered nurse after graduation.
• Minimum 1 year experience in case management or discharge planning.
• Competent with basic to intermediate computer skills.

Responsibilities

• Oversee quality and resource management for admitted patients across care continuum.
• Promote cost containment and lead integration of care across providers.
• Conduct admission and concurrent record reviews for medical necessity and severity.

Skills

Case management

Discharge planning

Nursing management

Electronic Health Records

Clinical documentation

Education

Active RN license

BSN preferred

Tools

Milliman Criteria

InterQual Criteria

Job description

North Vista Hospital, part of Prime Healthcare, seeks an experienced RN Case Manager to oversee admission and discharge planning while coordinating care for a seamless patient experience.

Responsibilities include quality resource management, promoting cost containment, and leading interdisciplinary collaboration to achieve optimal outcomes. Requires 5+ years as an RN, 1+ year case management, and solid computing skills.