Utilization Review Nurse

- CA Registered Nurse

The Utilization Review Nurse is responsible for utilization review, utilization management, and quality assurance activities for assigned services/areas/patients within the Cottage Health System and will champion, engage, manage and monitor proactive communications and interventions by and between relevant stakeholders with regard to utilization review management.

The Utilization Review Nurse will work collaboratively and proactively with the medical staff, nursing staff, and other disciplines to support and achieve the goals of the collaborative care process. Additional responsibilities include: maintain a working knowledge of regulations and provider contracts governing coverage of inpatient services (i.e., Medicare, Medi-Cal, Contracted Medical Groups); maintain and model interpersonal skills and productive relationships that allow for and support effective interaction with a wide variety of stakeholders; consistently demonstrate professionalism and compassion with regard to human dignity, preserving and protecting client autonomy and rights and with respect for patient/family values and beliefs. Utilization review activities will result in quality outcomes, optimal care/cost management of services and/or procedures, a high level of customer satisfaction, and contribution to an overall value-oriented experience of stakeholders and persons served.

California RN licensure and a minimum of two years direct patient care in an acute care setting. Ability to use an electronic medical records system. Certification in Case Management preferred.