Utilization Review Nurse - Full-Time

apartment UHS location_onTemecula, CA 92590, US

Responsibilities

Join the Southwest Healthcare Team!

About Us:

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.

Southwest Healthcare is comprised of five acute care hospitals and several non-hospital access points, including: Corona Regional Medical Center, Palmdale Regional Medical Center, Southwest Healthcare Rancho Springs Hospital, Southwest Healthcare Inland Valley Hospital and Temecula Valley Hospital, Temecula Valley Day Surgery, A+ Urgent Care Centers, and Riverside Medical Clinics. For more information on how to join our dynamic team, please visit our website at www.swhealthcaresystem.com.

Job Summary:

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 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.

Qualifications

Experience/Training/Experience:

Associates 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 of inpatient Care Management and/or Utilization Review experience required.

Certifications/Licenses:

Current license as a RN in the State of California required.

Other Skills and Abilities:

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.

Benefit Highlights:

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

Southwest Healthcare is owned and operated by subsidiaries of Universal Health Services, Inc. (UHS), a King of Prussia, PA-based company, one of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

EEO Statement:

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.

Avoid and Report Recruitment Scams:

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 subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

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