Valley Children's Healthcare
Utilization Review Program Coordinator RN
Valley Children's Healthcare, Madera, California, United States, 93638
Job Summary
The Utilization Review Nurse Coordinator is accountable for oversight of the Utilization Management (U.M.) program at Valley Children's Healthcare, under the direction of department leadership. Under minimal supervision, the UR Nurse Coordinator reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. The position combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments, problem identification and education, the coordinator will facilitate the quality of health care delivery in the most cost effective manner. The coordinator will ensure compliance with all regulations related to Utilization Management, will develop quarterly reports for the U.M. Medical Director for presentation at Pharmacy Therapeutics & Utilization (PT&AU) committee, and will facilitate UM subcommittee meetings.
Education
College Degree - 2 year Nursing (required)
College Degree - 4 year Nursing or related field (preferred)
Licenses and Certifications
RN - Reg Nurse (required)
Work Experience
Minimum five (5) years Full time equivalent RN experience in an acute care hospital. (required)
Pediatric experience and experience in Case Management and/or Utilization Review. (preferred)
Skills and Abilities
Computer Skills • Knowledge of UM regulations. • Knowledge of private and public payer reimbursement practices and procedures. • Excellent organizational and communication skills and ability to work with a variety of health care professionals. • Ability to work independently.
Computer Skills Proficiency with word processing, spreadsheets and database software.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Compensation Range $53.00 - $82.00
Workshift Day (United States of America)
Position Exempt No
FTE % 100
Scheduled Weekly Hours 40
Daily Hours 8
Have Questions? Call Recruitment Services at 559-353-7071 or email us at recruiting@valleychildrens.org. Disclaimer: Final compensation will be dependent upon skills and experience.
#J-18808-Ljbffr
Education
College Degree - 2 year Nursing (required)
College Degree - 4 year Nursing or related field (preferred)
Licenses and Certifications
RN - Reg Nurse (required)
Work Experience
Minimum five (5) years Full time equivalent RN experience in an acute care hospital. (required)
Pediatric experience and experience in Case Management and/or Utilization Review. (preferred)
Skills and Abilities
Computer Skills • Knowledge of UM regulations. • Knowledge of private and public payer reimbursement practices and procedures. • Excellent organizational and communication skills and ability to work with a variety of health care professionals. • Ability to work independently.
Computer Skills Proficiency with word processing, spreadsheets and database software.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Compensation Range $53.00 - $82.00
Workshift Day (United States of America)
Position Exempt No
FTE % 100
Scheduled Weekly Hours 40
Daily Hours 8
Have Questions? Call Recruitment Services at 559-353-7071 or email us at recruiting@valleychildrens.org. Disclaimer: Final compensation will be dependent upon skills and experience.
#J-18808-Ljbffr