Registered Nurse Utilization Review

Job Summary:


We seek a highly skilled and experienced Registered Nurse with specialties in Medical/Surgical, ICU, ER, Psychiatric, Labor & Delivery, PACU, or Operating Room to perform utilization review duties. The Registered Nurse will be responsible for evaluating patient care needs, ensuring appropriate use of healthcare resources, and collaborating with the interdisciplinary team to optimize patient outcomes. This role requires strong clinical assessment, communication, and collaboration skills, along with at least two years of nursing experience and an active California RN license.

Responsibilities:

• Conduct utilization reviews to assess the necessity, appropriateness, and efficiency of healthcare services.
• Perform patient assessments and review medical records to support case management decisions.
• Collaborate with healthcare providers, case managers, and interdisciplinary teams to ensure quality patient care.
• Assist in treatment planning and coordination of care based on clinical findings.
• Document and report findings accurately and timely in accordance with facility policies.
• Maintain compliance with regulatory requirements and facility standards.

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.
• Bachelor's degree in Nursing or related field.
• Driver's license, car insurance, and automobile if field work is required.

Preferred Skills & Certifications:

• Experience in utilization review or case management preferred.
• Familiarity with electronic medical record systems and utilization review software.
• Additional certifications related to case management or utilization review.

Special Considerations:

• Must hold a valid California RN license.
• Work primarily involves office-based utilization review; occasional field work may require travel.
• Strong ability to work independently and collaborate with diverse healthcare teams.

Scheduling:

• Standard work hours from 8:00 AM to 4:30 PM or 9:00 AM to 5:30 PM Pacific Standard Time.
• Full-time position with weekday schedule.