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Utilization Mgmt Nurse

Loma Linda University Health
San Bernardino, USA
Junior · 2+ years experience
Onsite
Discovered 2 days ago

Full Job Posting

Education and Experience

  • Associate's Degree in Nursing required. Bachelor's Degree in Nursing preferred. Minimum two years of Acute Care Hospital experience required. Hospital utilization review or case management experience preferred.
  • Appropriate levels of care, Utilization Review (UR), Utilization Management (UM), Case Management (CM), claims familiarity, clinical pathways, billing and coding regulations. Ability to analyze and interpret data; judge and act on analysis of data; apply mathematics to manipulate/analyze data; analyze and solve specific problems; Able to read; write and speak with professional quality; use computer and software programs necessary to the position, e.g., Word, Excel, Power Point, Access; operate/troubleshoot basic office equipment required for the position. Able to relate and communicate positively, effectively, and professionally with others; provide leadership; be assertive and consistent in enforcing policies; work calmly and respond courteously when under pressure; lead, supervise, teach, and collaborate; accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; work independently; perform basic math and statistical functions; manage multiple assignments; compose written material; work well under pressure; problem solve; organize and prioritize workload; recall information with accuracy; pay close attention to detail. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.

Knowledge and Skills

  • Appropriate levels of care, Utilization Review (UR), Utilization Management (UM), Case Management (CM), claims familiarity, clinical pathways, billing and coding regulations. Ability to analyze and interpret data; judge and act on analysis of data; apply mathematics to manipulate/analyze data; analyze and solve specific problems; Able to read; write and speak with professional quality; use computer and software programs necessary to the position, e.g., Word, Excel, Power Point, Access; operate/troubleshoot basic office equipment required for the position. Able to relate and communicate positively, effectively, and professionally with others; provide leadership; be assertive and consistent in enforcing policies; work calmly and respond courteously when under pressure; lead, supervise, teach, and collaborate; accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; work independently; perform basic math and statistical functions; manage multiple assignments; compose written material; work well under pressure; problem solve; organize and prioritize workload; recall information with accuracy; pay close attention to detail. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.
  • Licensures and Certifications: Active California Registered Nurse (RN) license required. Certified Professional in Healthcare Management (CPHM), Certified Professional Utilization Review (CPUR) or Certified Professional Utilization Management (CPUM) preferred.

Preferred Qualifications

  • Associate's Degree in Nursing required. Bachelor's Degree in Nursing preferred. Minimum two years of Acute Care Hospital experience required. Hospital utilization review or case management experience preferred.
  • Licensures and Certifications: Active California Registered Nurse (RN) license required. Certified Professional in Healthcare Management (CPHM), Certified Professional Utilization Review (CPUR) or Certified Professional Utilization Management (CPUM) preferred.

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