Utilization Review Program Coordinator RN

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.

• College Degree - 2 year Nursing (required)
• College Degree - 4 year Nursing or related field (preferred)

• RN - Reg Nurse (required)

• 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)

• 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.

$53.00 - $82.00

Day (United States of America)

No

100

40

8

Call Recruitment Services at  or email us claimer:
Final compensation will be dependent upon skills and experience.