RN Utilization Management Nurse - Inpatient - CMC Utilization Management - Full Time - 8 Hour - PMs
John Muir Health
Concord, CA
21 days ago
$88.03 - $118.84
Job Description
As an Inpatient Utilization Management Nurse at John Muir Health, you will advocate for patients by managing inpatient care, ensuring medical necessity, and collaborating with healthcare teams. This role involves analyzing utilization patterns, supporting quality improvement initiatives, and working closely with payers for reimbursement processes.
Key Responsibilities
Conducts utilization reviews to ensure medical necessity of inpatient cases
Collaborates with medical staff and case management teams for patient care
Participates in quality improvement activities and identifies trends in utilization
Communicates with payers to secure appropriate reimbursement
Required Qualifications
Bachelor of Science in Nursing from an accredited school
1 year Nursing - Utilization Review
RN Registered Nursing - California Board of Registered Nursing
Preferred Qualifications
2 years Case Management
3 years Nursing Medical/Surgical or Critical Care Nursing
Experience with software systems for inpatient documentation (e.g., EPIC)