Utilization Management Registered Nurse (Rn), Full Time, Days

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services.

The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

The Utilization Management (UM) RN performs utilization review activities, including, but not limited to, precertification, ensures appropriate level of care and status (Inpatient, Outpatient, and Observation) throughout admission and performs initial reviews, concurrent reviews, and retrospective reviews according to guidelines. Determines the medical necessity of requests by performing first level reviews. The UM nurse ensures a process that is efficient for providing care, ensuring timely and appropriate levels of care for the incoming patients. UM RN is responsible for preparing cases for Physician Advisor for 2nd level review. UM RN delegates accordingly to LVN and works in conjunction with a multi-disciplinary team to manage the care of patients in an ethical and fiduciary responsible manner.

Required Skills

• Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility and prioritization skills with minimal supervision.
• Highly developed ability to multi-task and maintain focus
• Type 50 WPM
• Ability to follow chain of command
• Proactive, can-do approach and desire to build positive working relationships through collaborative problem-solving
• Ability to apply appropriate UM criteria
• Excellent verbal and written communication skills
• Basic computer skills: Word, Excel, PowerPoint, Outlook. Able to utilize multiple electronic systems.
• Strong organizational skills

Required Experience

• A minimum of 2 years of case management experience.
• BSN preferred
• A minimum of 2 years of bedside nursing experience in an acute care setting.
• Current licensure as an RN in the state of California.
• Experience with Milliman Care Guidelines (MCG)
• Knowledge of payer requirements.
• Certified Case Manager or Accredited Case Manager preferred

Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V

Address
11500 Brookshire Ave.
Salary
49.37-81.30
Shift
Days
FLSA Status
Non-Exempt
Zip Code
90241