RN Central Utilization Review Nurse
UHS
Summary
The Southwest Healthcare Regional office in Temecula, CA is seeking a Full-Time RN Central Utilization Review Nurse who will be responsible for carrying out utilization management functions by planning, coordinating, and managing patient needs during hospitalization and throughout the continuum of care.
Job description
Duties include but not limited to:
- Conducts admission and continued stay reviews per guidelines to ensure medical necessity of level of care and hospitalization for multiple entities.
- Reviews medical record for presence of accurate placement orders reconciles variances with patient providers.
- Works collaboratively with attending providers, specialty providers, and physician advisors to ensure application of evidence-based guidelines for determining appropriate status.
- Collaborates with Patient Access team to ensure correct payer source for hospitalization and communication.
- Ensures compliance of utilization review practices as required by payers, external regulatory agencies, and organization.
Hybrid schedule may be considered after 90 days of employment. Must be available to work weekends and holidays.
Requirements
- Associates degree in Nursing or Graduate of a Vocational Nursing school required.
- Two (2) years of clinical experience in an acute care hospital setting required.
- One (1) year in an inpatient or outpatient case management setting required.
- Current license as a RN in the State of California required.
- Demonstrates knowledge and ensures compliance with the Nurse Practice Act, The Joint Commission and Title 22 standards and guidelines.
- Demonstrates compliance with hospital policies and procedures at all times.
- Demonstrates strong leadership, organization, communication and interpersonal skills.
- Demonstrates ability to relate to clinical personnel and medical staff, as well as ability to interact well with the public.
- Must have knowledge of PC and applications.
- Capable of resolving escalated issues arising from operations and requiring coordination with other.
- Knowledgeable in Interqual guidelines.
Benefits
- Medical, Dental & Vision
- Prescription Drug Plans
- 401(k) Matching
- Discounted Stock Plan
- SoFi Student Loan Refinancing
- Tuition Reimbursement
- CEU Reimbursement
- Certification Reimbursement
- License Reimbursement
- Paid Time Off
Company overview
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected providers of hospital and healthcare services, operating as a Fortune 300 corporation headquartered in King of Prussia, Pennsylvania. Founded in 1979, UHS has grown into a major healthcare enterprise with approximately 99,000 employees and annual revenues exceeding $14 billion. The company operates through its subsidiaries, managing 29 acute care hospitals, 331 behavioral health facilities, and 60 outpatient and other facilities across 39 U.S. states, Washington D.C., Puerto Rico, and the United Kingdom. UHS provides comprehensive healthcare services including acute care, behavioral health treatment, cancer centers, and ambulatory surgical centers. The company's strategy focuses on building or acquiring high-quality hospitals in rapidly growing markets and investing in advanced medical equipment and skilled personnel to become the leading healthcare provider in each community it serves. UHS is publicly traded on the New York Stock Exchange (NYSE: UHS) and has established a strong reputation for delivering compassionate, high-quality care while maintaining financial stability and operational excellence.