Utilization Management RN, CHOC Health Alliance
$110,094 - $181,626 per year
Key Skills
Job Description
Work Location
Orange, California
Work Shift
Why CHOC?
At CHOC, we strive to be the leading destination of children’s health by providing exceptional and innovative care. We are responsible for the overall health of our community’s pediatric population in our hospitals, clinics, and practices. And because of our breadth of care, your career at CHOC can be as diverse and fulfilling as you determine. CHOC’s compensation structure, benefits offerings, and career development programs are geared to helping you achieve your professional and personal goals. Apply now to see where your career at CHOC can take you.
Environmental Sustainability Statement
Driven by the connection between children's health and a healthy environment, we commit to creating a healthcare model that incorporates environmental sustainability aligned with our mission to protect children's health and patient safety.
Job Summary
The Utilization Management (UM) RN utilizes independent clinical judgement and expertise to coordinate benefit management, and promote quality, cost- effective health care. The UM RN works both independently, while also collaborating with the Medical Director and entire UM team, to ensure requests are reviewed with consideration to medical necessity, appropriateness of requested services and compliance with regulatory guidelines. This position requires attention to detail, outstanding organizational skills and efficient work habits.Pay Range
Minimum $110,094 Midpoint $145,870 Maximum $181,626Rate of pay is determined by various factors, including but not limited to knowledge, skills, competencies, experience, education, as well as position requirements.
Experience:
* Required: Minimum of two (2) years of pediatric experience
* Preferred: One or more years of Utilization or Case Management experience
Education:
* Required: Bachelor of Science in Nursing degree (BSN)
Specialized Skills:
* Required: Able to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision.
* Preferred: Experience with Cerner, MCG or other evidence-based clinical guidelines; EZ-Cap and/or Microsoft Office
Licensure:
Required: California Registered Nurse license.
• Preferred: Basic Life Support (BLS) certification.
Work Environments - Functional Demand:
Light - Moderate energy level Lift and carry 25-35 lbs. Push/pull 50-100 lbs. (ie. empty bed, stretcher).Physical Activity Requirements:
Bending, Carry Objects, Climbing, Keyboard use/repetitive motion, Pinching/fine motor activities, Push/Pull, Reaching forward, Reaching overhead, Sitting, Squat/kneel/crawl (Squad & Knee), Standing, Talk or hear, Taste or smell, Twisting, Walking, Wrist position deviationPhysical Activity Lifting
Lifting (Floor to waist level) - Occasional 0-35%, Lifting (Waist level and above) - Occasional 0-35%Sensory Requirements:
Color Discrimination, Depth Perception, Far Vision, Hearing, Near VisionEnvironment Requirements:
Airborn Communicable Disease, Bloodborne Pathogens, Chemical, Dust Particular Matter, Extreme Noise Levels, Extreme Temperatures, Radiation, Uneven Surfaces or ElevationsNon-Discrimination Statement:
CHOC does not discriminate on the basis of age, race, color, religion, national origin, ancestry, marital status, genetic information, disability, sex, gender (including pregnancy, breastfeeding, childbirth, lactation or related medical conditions), gender identity or expression, medical condition, sexual orientation, veteran status, military or uniformed service member status, or other protected characteristics in accordance with state and federal laws.
We encourage individuals from all backgrounds to apply for positions at CHOC, even if your experience doesn’t align perfectly with the listed qualifications for a particular role, as your unique experience may be a great addition to our culture for another one of our opportunities.
If you desire support or accommodations throughout the Talent Acquisition process, please inform your Talent Acquisition Partner.
Core Responsibilities
The Utilization Management RN uses independent clinical judgment and expertise to coordinate benefit management and promote quality, cost-effective healthcare. This involves collaborating with the Medical Director and the UM team to review requests based on medical necessity, appropriateness of services, and compliance with regulatory guidelines.
Requirements
Required qualifications include a minimum of two years of pediatric experience and a Bachelor of Science in Nursing (BSN) degree, along with an active California Registered Nurse license. Candidates must possess strong skills in communication, critical thinking, organization, and attention to detail.
About CHOC
Industry: Hospitals and Health Care
Company size: 1,001-5,000 employees
Affiliated with the University of California, Irvine, CHOC's growing pediatric healthcare system is comprised of premier facilities, leading-edge programs and services, life-saving research, healing amenities, and education and training programs designed to prepare the next generation of pediatric experts. Our mighty brigade of physicians, nurses and staff—each sharing a deep connection to our mission— are dedicated to caring for children, whether they’re healthy or seriously ill. So, kids can get back to being kids.