Utilization Management Registered Nurse

Job Summary

The Utilization Management Nurse supports the case management department by
providing a variety of utilization management functions including but not
limited to 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 to address concerns and other
duties as assigned. The Utilization Management Nurse will work collaboratively
with the Utilization Nurse Program Coordinator to ensure compliance with
regulatory, organizational and department requirements. The Utilization Review
Nurse will receive direction from the Utilization Review Program Coordinator for
daily and long term tasks and projects.

Qualifications

Education

* Associates Degree Nursing (required)
* Bachelors Degree Nursing or related field (preferred)

Licenses and Certifications

* RN - Registered Nurse License - CA-BRN - California Board of Registered
Nursing (required)

Work Experience

* Minimum three (3) years Full time equivalent RN experience in an acute care
hospital. (required)
* Pediatric experience and experience in Case Management and/or Utilization
Review. (preferred)

Skills and Abilities

* Knowledge of UM regulations.
Knowledge of private and public payer reimbursement practices and procedures.
Excellent organizational and communication skills and ability to work with a
variety of health care professionals.
Ability to work independently.
* Computer Skills Proficiency with word processing, spreadsheets and database
software.

To perform this job successfully, an individual must be able to perform each
essential duty satisfactorily. The requirements listed above are representative
of the knowledge, skill, and/or ability required. Reasonable accommodations may
be made to enable individuals with disabilities to perform the essential
functions.

Compensation Range

$57.29 - $81.72

Workshift

Day (United States of America)

Position Exempt

No

FTE %

90

Scheduled Weekly Hours

36

Daily Hours

8

Have Questions?

Call Recruitment Services at 559-353-7071 or email us at
recruiting@valleychildrens.org
Disclaimer: Final compensation will be dependent upon skills and experience.