Utilization Review Nurse

Cottage Health seeks a Utilization Review Nurse for their CH Clinical Denials and Appeals department responsible for utilization review, utilization management, and quality assurance activities for assigned services/areas/patients within the Cottage Health System and will champion, engage, manage and monitor proactive communications and interventions by and between relevant stakeholders with regard to utilization review management.

Utilization review activities will result in quality outcomes, optimal care/cost management of services and/or procedures, a high level of customer satisfaction, and contribution to an overall value-oriented experience of stakeholders and persons served in a manner compliant with The Joint Commission, HIPAA and Title 9 Regulations (DHCS).

Responsibilities include:



* The Utilization Review Nurse will work collaboratively and proactively with the medical staff, nursing staff, and other disciplines to support and achieve the goals of the collaborative care process.


* Additional responsibilities include: maintain a working knowledge of regulations and provider contracts governing coverage of inpatient services (i.e., Medicare, Medi-Cal, Contracted Medical Groups); maintain and model interpersonal skills and productive relationships that allow for and support effective interaction with a wide variety of stakeholders; consistently demonstrate professionalism and compassion with regard to human dignity, preserving and protecting client autonomy and rights and with respect for patient/family values and beliefs.

QUALIFICATIONS:

All job qualifications listed indicate the minimum level necessary to perform this job proficiently.

Education:


* Minimum: Minimum education to allow candidate to achieve California RN license.


* Preferred: Bachelor's Degree in Nursing (BSN).

Certifications, Licenses, Registrations:


* Minimum: Current California Registered Nurse license in good standing.


* Preferred: Certification in Case Management.

Technical Requirements:


* Minimum: Ability to use an electronic medical records system and other clinical systems, such as AllSCRIPS, CPOE, and/or SUNRISE.

Years of Related Work Experience:


* Minimum: Minimum of two years direct patient care RN experience in an acute care setting.

Other direct patient care RN experience may be considered.


* Preferred: 3 years of experience as a Utilization Review Nurse in an acute care setting.

Cottage Health is a leading acute care hospital system, located on the central coast of California, widely known for our superior patient care, innovation, medical research and education.

Our health system operates primarily in Santa Barbara, Ca, since 1888, and consists of three acute care hospitals, a Rehabilitation Hospital, multiple clinics and a multi-site Urgent Care system.

Our mission is to serve the central coast communities with excellence, integrity, and compassion.

Every day we touch thousands of lives in many differe...