Utilization Management Registered Nurse

Utilization Management Registered Nurse Valley Children's Healthcare

• 3.6 Madera, CA Job Details Full-time $53
• $82 an hour 9 hours ago Qualifications Collaborate with healthcare professionals RN License Word processing Spreadsheets Health insurance knowledge Acute care experience Productivity software Healthcare reimbursement methods Associate's degree Associate Degree in Nursing Database software proficiency Full Job Description Madera, California, 93636

Job Summary:

The Utilization Management Nurse supports the case management department by providing a variety of utilization management functions including but not limited to daily screening of patient admission relative to specified criteria, active involvement in denial management, acting as a resource to staff regarding clinical criteria, communication with payors to address concerns and other duties as assigned. The Utilization Management Nurse will work collaboratively with the Utilization Nurse Program Coordinator to ensure compliance with regulatory, organizational and department requirements. The Utilization Review Nurse will receive direction from the Utilization Review Program Coordinator for daily and long term tasks and projects.

Qualifications:

Education Associates Degree Nursing (required) Bachelors Degree Nursing or related field (preferred) Licenses and Certifications RN

• Registered Nurse License
• CA-BRN
• California Board of Registered Nursing (required) Work Experience Minimum three (3) years Full time equivalent RN experience in an acute care hospital.

(required) Pediatric experience and experience in Case Management and/or Utilization Review. (preferred) Skills and Abilities Knowledge of UM regulations. Knowledge of private and public payer reimbursement practices and procedures. Excellent organizational and communication skills and ability to work with a variety of health care professionals. Ability to work independently. Computer Skills Proficiency with word processing, spreadsheets and database software. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Compensation Range:

$53.00

• $82.

00

Workshift:

Day (United States of America)

Position Exempt:

No FTE %: 90

Scheduled Weekly Hours:

36

Daily Hours:

8 Have Questions? Call Recruitment Services at 559-353-7071 or email us at

Disclaimer:

Final compensation will be dependent upon skills and experience.

ALERT :

Valley Children's Healthcare has been made aware of malicious employment scams targeting candidates with false job offers and requests for personal information. Please stay vigilant. If you believe you've encountered a potential hiring scam claiming to be from Valley Children's Healthcare, please report it to . Job Details Career area Nursing

• Other Position Type Full Time Date Posted 06/29/2026 Location Madera, CA 93636, United States Job ID JOB_POSTING-3-2018 About Valley Children's With more than 670 physicians and 3,500 staff, Valley Children's Healthcare delivers high-quality, comprehensive care to more than 1.

3 million children across Central California. Our 358-bed stand-alone children's hospital and network of specialty care centers and primary care practices offer advanced pediatric services

• from cancer and blood disorders to heart care and neonatal intensive care, serving children with conditions ranging from routine to rare and complex. Beyond clinical care, Valley Children's is also a catalyst for community health
• partnering with schools, nonprofits and public agencies to expand access, promote wellness and support the long-term success of children and families throughout the region.