Utilization Review RN

Job title: Utilization Review RN in Glendale, CA - Los Angeles, CA at CommonSpirit Health

Company: CommonSpirit Health

Job description: The posted compensation range of $53.66 - $72.87 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.Requisition ID 2025-411795 Employment Type Full Time Department Utilization Review Hours/Pay Period 80 Shift Day Weekly Schedule Weekdays and every other weekend (0700 - 1530) Remote Yes Category Case Management and Social Work Union CNAResponsibilitiesResponsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking. Collaborates with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies. Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions. Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market.
Qualifications

• Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience.


• California RN license.


• AHA BLS


• Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used.


• Proficient in application of clinical guidelines (MCG/InterQual) preferred


• Knowledge of managed care and payer environment preferred.


• Must have critical thinking and problem-solving skills.


• Collaborate effectively with multiple stakeholders


• Professional communication skills.


• Understand how utilization management and case management programs integrate.


• Ability to work as a team player and assist other members of the team where needed.


• Thrive in a fast paced, self-directed environment.


• Knowledge of CMS standards and requirements.


• Proficient in prioritizing work and delegating where indicated.


• Highly organized with excellent time management skills.

Preferred

• Graduate of an accredited school of nursing (Bachelor's Degree in Nursing (BSN)) or related healthcare field.


• At least five (5) years of nursing experience.


• Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification

OverviewFounded in 1926, Glendale Memorial Hospital and Health Center is a 334-bed, acute care, nonprofit, community hospital located in Glendale, California. The hospital offers a full complement of services, including its award winning heart center, the colorectal surgery institute, a gastrointestinal program, and is a Los Angeles County approved primary stroke center. The hospital shares a legacy of humankindness with Dignity Health, one of the nation's five largest health care systems. Visit https://www.dignityhealth.org/socal/locations/glendalememorial for more information.Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible employees may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit .Map this locationLook for gyms, restaurants, doctors and schools in the area.No featured jobsNo recently viewed jobsYou have no saved jobsLoad moreFollow us on social mediaEqual OpportunityCommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law.Read MoreCommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.

Expected salary: $53.66 - 72.87 per hour

Location: Glendale, CA - Los Angeles, CA

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