Built-in 1973 Dignity Health Methodist Hospital of Sacramento is committed to providing daily excellence in health care for residents of Sacramento’s southern suburbs including the Elk Grove Wilton and Galt communities. Methodist Hospital is home to a 158 acute-care bed facility with 1120 employees 283 medical staff and 29 Emergency Department beds. Methodist Hospital also owns and operates Bruceville Terrace – a 171-bed sub-acute skilled nursing long-term care facility adjacent to the hospital that provides care for the elderly as well as those requiring extended recoveries. Methodist Hospital is home to the Family Medicine Residency Program an accredited and nationally recognized program which provides resident physicians with specialty training in primary care family medicine. Together the hospital and residency program implemented a ground-breaking curriculum addressing the identification treatment and assistance of human trafficking victims and created a one-of-a-kind health clinic for victims the Human Trafficking Medical Home.

Utilization Review RN - remote position

Position Summary: 

The incumbent is responsible for the review of medical records for appropriate admission status and continued hospitalization.

• Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking.
• Collaborates with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies. 
• Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions. 
• Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market.

We offer the following benefits to support you and your family:

• Health/Dental/Vision Insurance
• Flexible spending accounts
• Voluntary Protection: Group Accident Critical Illness and Identity Theft
• Adoption Assistance
• Free Premium Membership to Care.com with preloaded credits for children and/or dependent adults
• Employee Assistance Program (EAP) for you and your family
• Paid Time Off (PTO)
• Tuition Assistance for career growth and development
• Retirement Programs
• Wellness Programs

Minimum:

• Graduate of an accredited school of nursing
• Current California Registered Nurse License
• Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience.

• Knowledge, Skills, Abilities and Training:

  • Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used.
  • Proficient in application of clinical guidelines (MCG/InterQual) preferred
  • Knowledge of managed care and payer environment preferred.
  • Must have critical thinking and problem-solving skills.
  • Collaborate effectively with multiple stakeholders
  • Professional communication skills.
  • Understand how utilization management and case management programs integrate.
  • Ability to work as a team player and assist other members of the team where needed.
  • Thrive in a fast paced, self-directed environment.
  • Knowledge of CMS standards and requirements.
  • Proficient in prioritizing work and delegating where indicated.
  • Highly organized with excellent time management skills.

Preferred:

• Bachelor's Degree in Nursing (BSN) or related healthcare field. 
• At least five (5) years of nursing experience.
• Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification.