Lead Utilization Review Nurse (RN)

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, please visit our website at www.swhealthcaresystem.com.

Job Summary:

Southwest Healthcare is seeking a Full-Time Lead Utilization Review Nurse (RN) who will be responsible for partnering with the Director of Utilization Management to oversee the daily operations of the department. This includes monitoring the activities of clinical and support staff, and collaborating with hospital Case Management and physician teams across the region. This position will be onsite at the Regional Office in Temecula, CA. Duties include but not limited to:

• Oversight of day-to-day operations of centralized utilization review department, including timecards, training, daily assignments, meetings, schedule, auditing, and intercept daily inquires.
• Reviews medical record for presence of accurate placement orders and 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.
• Completion of timely and concurrent communication of clinical reviews to payers.
• Obtains inpatient authorizations from payers to support level of care and inpatient hospitalization.
• Ensures compliance of utilization review practices as required by payers, external regulatory agencies, and organization.
• Documentation of avoidable delays in discharge per guidelines.
• Perform all other duties as assigned.

Experience/Training/Experience:

• Associate degree in nursing required.
• Two (2) years of clinical experience in an acute care hospital setting required
• Two (2) years 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!

Southwest Healthcare is owned and operated by subsidiaries of Universal Health Services, Inc. (UHS), a King of Prussia, PA-based company, that is one of the largest healthcare management companies in the nation.

UHS is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or e-mails. All resumes submitted by search firms to any employee at UHS; via e-mail, the Internet or in any other form and/or method without a valid written search agreement in place for the above-listed position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.

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.

Notice:

At UHS and all subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates with matching skillset and experience with the best possible career at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail etc. If you feel suspicious of a job posting or job-related email, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.