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Registered Nurse - Utilization Review

Location: Montebello, California

Date Posted: 16 Jun, 2022

The Utilization management nurses role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays.

Job Duties and Responsibilities:
Concurrent review of patient’s clinical information for efficiency
Ongoing review of precertification requests for medical necessity
Monitor the activities of clinical and non-clinical staff
Coordinates patient’s discharge planning needs with the healthcare team
Employ effective use of knowledge, critical thinking, and skills to:
Advocate quality care and enhanced quality of life
Prevent patient complications during hospital stay
Advocate decreased hospital stay when appropriate
Maintain accurate records of all patient related interactions
Prepare monthly patient management and cost savings report
Work in an intensive, fast-paced environment with minimal supervision
Ability to stay organized and interact well with others in any situation
Provide daily updates to Manager of Utilization Management for review