Utilization Review Nurse

Prime Healthcare

Posted 1 year ago

Listing Type: Nursing
Employment Type: Nursing
Shift: Not Stated
Education Level: ADN/ASN
Certificates: Not Stated
Experience Level: All|Experienced
Compensation: NA

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Utilization Review Nurse

Position Id

UR_RNphsi

Job Organization

PRIME HEALTHCARE SERVICES HQ,

Job Type

1 Regular/Full time Jobs

Status

Active

Hours

Job Location

3300 East Guasti Road, ONTARIO, SAN BERNARDINO, CALIFORNIA, UNITED STATES - 91761

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Job summary

Job description/Responsibilities:  The Utilization Review Nurse is responsible for maximizing the quality and cost efficiency for the EPO Plan. Utilization Review Nurse will set up processes, systems, and measures of performance with our Prime Hospitals, Prime Physicians and our employees related to effective authorization and care management programs in our employee health plan. This position will work closely with the Corporate Utilization Review Department, Prime Healthcare Case Managers, Social Workers, and Discharge Planners.

Company Policy: We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender,gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.
EEO is the Law: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf

Required Qualification:  1. Post graduate of an accredited school of nursing and an active CA Registered Nurse license. 2. Five (5) years experience in acute hospital case management or equivalent. 3. Utilization Management experience required. 4. Proficient in word processing, spread sheets and database. 5. Excellent interpersonal relationship skills with exceptional professional work ethics. 6. Knowledge of Milliman Care Guidelines, InterQual Criteria, and CMS. 7. Experience and knowledge of self-funded plans, ERISA, and HIPPA guidelines.

Experience: Minimum 5 Years

Job Family: Healthcare Practitioners and Technical Occupations

Occupations: Registered Nurses

Degree Required: Associate/Diploma Or Higher

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Catherine Rhodes
Catherine Rhodes


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