Providence Health & Services RN Utilization Review Case Manager in Mission Hills, California
Providence is calling a Registered Nurse (RN) Utilization Review Case Manager (Full-Time/Day Shift) to Providence Facey Medical Foundation in Mission Hills, CA.
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We are seeking a Registered Nurse (RN) Utilization Review who will be responsible for utilization review which includes coordination of services for medical necessity, cost effectiveness, timelines of service and ensuring that quality standards are met. Performs coordination of services for members to ensure that services are medically necessary, cost effective, provided in a timely manner and meet local standards of care.
In this position you will:
Act as a resource for utilization management activities.
Deliver upon the service expectations of both our patients and fellow staff members by listening to their needs; engaging in positive interactions; and following through on expectations made in a thoughtful, efficient, timely and courteous manner so that their total outcome is better than expected.
Respect the dignity, confidentiality and privacy of patients.
Work in a safe manner, adhering to general safety precautions and standards. Reports any unsafe conditions to their supervisor and/or the safety hotline.
Assist with review and processing of the UR requests.
Attend weekly UR meetings and other meetings as indicated.
Provide coverage at all prime locations in both the hospital and skilled nursing locations as scheduled.
Document as instructed in the EMR.
Maintain confidentiality of all patient and Utilization Management information.
Maintain a high degree of professionalism:
Demonstrate the ability to make decisions, take appropriate action and follow tasks through to completion.
Recognize and analyze the implications of new situations and develops workable solutions to maintain productivity and morale.
Act as a role model in demonstrating the customer service standards of the organization.
Demonstrate a commitment to personal growth and development by participating in external activities related to professional goals.
Respond cooperatively to managers and staff members in other departments to promote teamwork
Attend departmental meetings as appropriate and contributes ideas for improving efficiency, productivity and patient satisfaction
Demonstrate behaviors which are consistent with the Code of Conduct and aligned with the organization’s mission, vision and shared values:
Report promptly any suspected or potential violations to laws, regulations, procedures, policies and practices, and cooperates in investigations.
Conduct all transactions in compliance with all company policies, procedures, standards and practices.
Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position.
Ensure that appearance and personal conduct are professional at all times.
Required qualifications for this position include:
RN graduate of an accredited school of nursing.
Current unrestricted California RN license.
Strong clinical background preferably in acute care or home health.
Must possess excellent customer service and communication skills.
Must be organized and a self starter, be able to utilize multiple resources to determine health plan requirements and benefits as applied to the utilization and case management process and clinical decision making.
Must have working understanding of MS Outlook, Word and Excel and be capable of being trained in referral processing software.
Preferred qualifications for this position include:
Three (3) years experience in a managed care setting/utilization review/discharge planning/case management.
About the hospital you will serve.
Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita and Simi Valleys. The group began as a single medical practice over 90 years ago.
Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Case Management
Location: California-Mission Hills
Req ID: 294887