RN Utilization Review

Job Summary and Responsibilities As our Utilization Review Nurse at the Utilization Management Hub, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision-making, regulatory compliance, and responsible resource utilization. Every day you will meticulously review medical records, authorize services, and prepare cases for physician review in partnership with UM teams. You'll monitor patient care for appropriateness, quality, and cost-effectiveness, aligning decisions with established criteria. To be successful in this role, you will possess a strong clinical background, deep UM/regulatory knowledge, and exceptional analytical/organizational skills. Your ability to manage charts, apply criteria precisely, and communicate effectively with enthusiasm, efficiency, and empathy is paramount for optimal patient care and operational flow. Responsibilities Conduct admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure hospitalization is warranted based on established criteria. Ensure compliance with utilization review principles, hospital policies, regulatory agencies, PRO, Joint Commission, and payer criteria for eligibility. Review records for accurate patient status orders and address deficiencies with providers. Ensure timely communication and follow‑up with physicians, payers, Care Coordinators and other stakeholders regarding review outcomes. Collaborate with facility RN Care Coordinators to ensure progression of care. Engage the second‑level physician reviewer, internal or external, as indicated to support appropriate status. Job Requirements Graduate of an accredited school of nursing Registered Nurse with current California license required. Minimum two (2) years of acute hospital clinical experience or a Master’s degree in Case Management or Nursing in lieu of 1 year experience required. Must be available to complete training on‑site at Northridge Hospital. Every other weekend required. Preferred Qualifications Certified Case Manager (CCM), Accredited Case Manager (ACM‑RN), or UM certification preferred. Knowledge of managed care and payer environment preferred. Critical thinking and problem‑solving skills. Bachelor’s degree in Nursing (BSN) or related healthcare field preferred. LA City Fire Card required within 90 days of hire. Where You'll Work Dignity Health – Northridge Hospital Medical Center is a 394‑bed, acute‑care, nonprofit hospital with a Level II Trauma Center, heart care, cancer care, and women’s health services. It is the only pediatric trauma center in the San Fernando Valley and has been recognized as an LGBTQ+ Healthcare Equality High Performer, a Joint Commission‑certified Thrombectomy‑Capable Stroke Center, and one of America’s 50 Best Hospitals. Pay Range $55.55 – $79.06 per hour #J-18808-Ljbffr CommonSpirit Health