Registered Nurse Utilization Review

Job Summary:

We seek a highly skilled and experienced Registered Nurse licensed in California to perform Utilization Review duties. The role involves assessing patient care needs, ensuring appropriate utilization of healthcare services, and collaborating with interdisciplinary teams to optimize patient outcomes. The nurse will provide expert clinical evaluation and support decision-making processes in a fast-paced environment. Responsibilities:

• Conduct thorough patient assessments to evaluate care requirements and resource utilization.
• Review and analyze clinical documentation to ensure compliance with regulatory and organizational standards.
• Collaborate with healthcare providers and interdisciplinary teams to coordinate patient care plans.
• Provide case management support and facilitate appropriate discharge planning.
• Document findings and communicate recommendations effectively to stakeholders.
• Participate in quality improvement initiatives related to utilization management.
• Maintain up-to-date knowledge of clinical guidelines and healthcare regulations.

Required Skills & Certifications:

• Active Registered Nurse license in the state of California.
• Minimum of two years' experience in hospital, home health, or hospice care.
• Strong clinical assessment, medication administration, and treatment planning skills.
• Excellent communication and interpersonal skills.
• Ability to collaborate effectively within interdisciplinary teams.
• Bachelor's degree in Nursing or related field.
• Driver's license, car insurance, and automobile for field work if required.

Preferred Skills & Certifications:

• Experience in Utilization Review or Case Management roles.
• Specialty experience in Medical/Surgical, ICU, ER, Psychiatric, Labor & Delivery, PACU, or Operating Room.
• Familiarity with healthcare regulatory requirements and utilization management software.

Special Considerations:

• Must hold a valid California RN license.
• Work involves collaboration in a fast-paced healthcare environment.
• Laptop, keyboard, and mouse will be provided by the facility.

Scheduling:

• Work hours are from 8:00 AM to 4:30 PM or 9:00 AM to 5:30 PM Pacific Standard Time.