Clinical Utilization Nurse

2 weeks ago


Dublin, California, United States Wellpath Full time
Why You Should Consider This Role

As a Clinical Utilization Nurse, you will play a pivotal role in enhancing the lives of those who are often overlooked. Join a purpose-driven organization that prioritizes a culture centered around people.

Key Highlights:
  • Make a meaningful impact in the lives of underserved populations
  • Be part of a mission-oriented team that values compassion and integrity
  • Opportunities for professional advancement and personal growth

Your Contributions Matter:

In this role, you will focus on:
  • Providing care to vulnerable and marginalized patients
  • Promoting diversity, equity, inclusion, and a sense of belonging
  • Enjoying autonomy within a supportive team environment
  • Engaging in continuous learning and development

Benefits and Perks:

We offer a comprehensive benefits package that includes medical, dental, and vision coverage, along with paid time off and a 401k plan. Our commitment to work-life balance ensures that you and your family can thrive both personally and professionally:
  • DailyPay: Access your earnings as you work
  • Tuition Assistance and scholarships for dependents
  • Employee Assistance Program (EAP) offering free counseling and health coaching
  • Company-paid life insurance
  • Tax-free Health Spending Accounts (HSA)
  • Wellness initiatives including fitness memberships and discounts
  • Preferred banking partnerships with reduced rates for loans

About Us:

Now is the time to make a significant difference in the lives of those who need it most. Our team is united by a shared passion for serving society's most vulnerable individuals. Every day, we have the privilege of providing compassionate care and support to those who require it the most.

At Wellpath, we see countless individuals in our facilities each month, many of whom receive critical clinical care. We are dedicated to ongoing training and development for all healthcare team members, ensuring access to top-tier clinical resources for education and support.

Your Role:

The Clinical Utilization Nurse will be responsible for:
  • Coordinating clinical care and managing utilization and care management activities in compliance with nursing standards and regulations.
  • Ensuring adherence to all relevant policies while delivering effective utilization management and care services.
  • Collaborating with a multidisciplinary team to provide optimal patient care.

Key Responsibilities:
  • Conducting utilization management activities, including prospective, concurrent, and retrospective reviews to assess the appropriateness of care levels and lengths of stay.
  • Communicating effectively with various hospital departments and establishing rapport with billing and medical records teams.
  • Assisting with billing procedures and communicating discharge needs to relevant personnel.
  • Utilizing databases and reference lists for third-party vendors and attending management meetings as necessary.
  • Maintaining up-to-date knowledge through educational workshops and reviewing relevant publications.

Qualifications:

Education:
Master's in Healthcare Administration or an unrestricted, current RN license in the state of practice.

Experience:
Minimum of two years of clinical experience with a focus on Utilization Management, preferably in a correctional or detention facility.

Licenses/Certifications:
Must maintain all necessary certifications and educational requirements for RN licensure, including current BLS certification through AHA.

We are an Equal Employment Opportunity / Affirmative Action Employer and celebrate diversity, striving to create an inclusive environment for all employees.

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