Utilization Management RN - San Diego, CA

UHG San Diego, CA

About the Job

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

 

The Utilization Management Nurse will be working at the Sheriff Medical office. The Utilization Management Nurse will be working at the Sheriff Medical office.  The registered nurse utilization reviewer will be working closely with the Sheriff's Managed Care Group and will be stationed in the administrative offices of the San Diego Sheriff's Medical Services Division and will have no direct inmate contact.  The position will be involved in reviewing records for outpatient specialty care referrals, inpatient utilization management and discharge planning for medical appropriateness and necessity in collaboration with a physician reviewer. 

 

Primary Responsibilities:

  • Detention facility coordination
  • Outpatient facility coordination
  • Transportation coordination
  • Information mapping process
  • Development and maintenance of audit processes for all operations
  • Facility and provider operational compliance
  • Reviewing all cases referred for outpatient specialty referrals
  • Database documentation of utilization review decisions referencing (InterQual) guidelines
  • Utilization reviews of inpatient cases
  • Inpatient case management and inter-facility transfers

Required Qualifications:

  • Current, unrestricted RN license in the state of California
  • 2+ years of experience with case management or utilization review
  • Acute care experience
  • Experience developing and presenting complex information both written and verbally
  • Experience with Microsoft Office Suite including Word, Excel, Outlook
  • Experience with EMR

Preferred Qualifications:

  • Experience with InterQual

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

 

 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

 

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

 

 

Job Keywords: RN, Registered Nurse, UM RN, UR RN, Utilization Review, Utilization Management, Case Manager, Interqual, Acute Care, hospital, detention facility, San Diego, SD, CA, California