Utilization Review RN

6 days ago


Madera, California, United States Madera Community Hospital Full time
We are seeking a highly motivated and detail-oriented Utilization Review Nurse to join our team at Madera Community Hospital. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the highest quality care and that our hospital operates efficiently and effectively.

About Us:
Madera Community Hospital is a General Acute Care, private, not-for-profit hospital located in the heart of Central California. We are committed to improving and maintaining the health and wellness of residents throughout the Central Valley, and we take pride in our reputation for providing exceptional patient care and service.

Job Description:
The Utilization Review Nurse will be responsible for assessing, planning, implementing, and evaluating the needs of patients for discharge planning and utilization review. This includes ensuring that patients receive the necessary care and services to meet their medical needs, while also minimizing costs and maximizing efficiency.

Responsibilities:
- Conduct thorough assessments of patients' medical needs and develop individualized plans for discharge and utilization review
- Collaborate with physicians, nursing staff, and other healthcare professionals to ensure seamless care transitions
- Develop and maintain relationships with payers and other stakeholders to ensure optimal reimbursement and billing practices
- Analyze data and trends to identify opportunities for process improvement and cost reduction
- Develop and implement policies and procedures to ensure compliance with regulatory requirements and industry best practices

Qualifications:
- Minimum of 1-3 years of experience in acute healthcare, preferably in case management or utilization review
- Current California Board of Nursing Registered Nurse License
- Current American Heart Association BCLS certificate, ACLS certificate preferred
- Knowledge of Medicare, Medicaid, HMO, and private insurance coverage criteria
- Excellent communication and interpersonal skills
- Ability to work effectively in a fast-paced environment, prioritizing tasks and managing multiple projects simultaneously

Salary:
$55.34-$66.41/hourly

Benefits:
- Comprehensive benefits package, including medical, dental, and vision insurance
- Retirement savings plan, including 401(k) matching program
- Generous paid time off policy, including vacation, sick leave, and holidays
- Opportunities for professional growth and development, including tuition reimbursement and continuing education programs

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