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Inpatient Utilization Review RN - Night Shift

Napa, CA · Healthcare
Inpatient Utilization Review RN - Night Shift
Napa, CA
Utilization Review Nurse Job Summary: 
  • The nurse plays an integral part in the coordination of care for patients and providing them the necessary resources, options, and coordination for a healthy care outcome.
  • The Utilization Review Nurse is responsible for utilization management or prior-authorized treatments, and the utilization review of concurrent patient treatment.
  • The Utilization Review Nurse will performs reviews of services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
  • Utilize clinical skills to provide and facilitate utilization review, continued stay reviews and utilization management of all cases based on clinical experience and recognized guidelines.
  • Shifts will typically be 8 pm to 4:30 am, with one weekend shift every 3 weeks.
Utilization Review Nurse Background: 
  • Current, valid, and unrestricted state Registered Nurse (R.N.) license.
  • Requires a bachelor degree in nursing (BSN) or other healthcare related field.
  • Certifications such as CPUR/CPUM/CPHM or CCM/ACM is preferred.
  • At least 2 years acute care clinical nursing experience is required.
  • Around 1-2 years of hospital utilization review, inpatient or outpatient case management, or discharge planning experience.
  • Will consider some combination of experience in case management, discharge planning, or utilization management experience in the acute, sub-acute, home health setting or managed care environment.
  • Knowledge of guidelines for Medicaid/Medicare and related state programs is a plus.
  • Highly prefer prior experience using InterQual / Milliman / MCG criteria for medical necessity, setting and level of care, and concurrent patient management.
  • Computer skills to include Microsoft Word, Excel, database use, and basic data entry.
480.429.4005 (CALL – TEXT – FAX)
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