Utilization Review Nurse

1 day ago Be among the first 25 applicants

Creating Health and Harmony, Southwest Healthcare is a comprehensive network of care with convenient hospital and ambulatory care/outpatient locations here to serve the Southern California community. With over 6,000 passionate providers and healthcare employees, our shared goal is to provide convenient access to a wide range of healthcare services in a way that benefits you, your family, and the entire community.

The Southwest Healthcare Regional office in Temecula, CA is seeking a Full‑Time 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. Duties include but are 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.

• Associate’s degree in Nursing or Graduate of a Vocational Nursing school required.
• Two (2) years of clinical experience in an acute care hospital setting with 1 year in inpatient Care Management and/or Utilization Review experience required.

• Current license as an 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.

• Challenging and rewarding work environment.
• Competitive Compensation & Generous Paid Time Off.
• Excellent Medical, Dental, Vision and Prescription Drug Plans.
• 401(k) with company match and discounted stock plan.
• SoFi Student Loan Refinancing Program.
• Tuition, CEU, Certification, Licenses Reimbursement program.
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: UHS Guest Benefits.

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our…