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Utilization Review RN

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American Nursing Care

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Location:
United States , Red Bluff

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Category:

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Contract Type:
Not provided

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Salary:

52.59 - 68.92 USD / Hour

Job Description:

The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients requiring these services. The RN Care Coordinator performs this role to meet the individual's health needs while promoting quality of care, cost effective outcomes and by following hospital policies, standards of practice and Federal and State regulations. The position’s emphasis will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care toward optimal outcomes at the appropriate level of care. The RN Care Coordinator advocates for the patient and family by identifying, valuing, and addressing patient choice, spiritual needs, cultural, language and socioeconomic barriers to care transitions. In addition, the RN Care Coordinator strives to enhance the patient experience.

Job Responsibility:

  • Overseeing the progression of care and discharge planning for identified patients requiring these services
  • Perform this role to meet the individual's health needs while promoting quality of care, cost effective outcomes and by following hospital policies, standards of practice and Federal and State regulations
  • Emphasis on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care toward optimal outcomes at the appropriate level of care
  • Advocate for the patient and family by identifying, valuing, and addressing patient choice, spiritual needs, cultural, language and socioeconomic barriers to care transitions
  • Strive to enhance the patient experience

Requirements:

  • Graduate of an accredited school of nursing
  • 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
  • RN license in the state(s) covered is required
  • BLS required within 3 months of hiring

Nice to have:

  • 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 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
What we offer:
  • Medical, prescription drug, dental, vision plans
  • Life insurance
  • Paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually)
  • Tuition reimbursement
  • Retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings

Additional Information:

Job Posted:
January 10, 2026

Employment Type:
Parttime
Work Type:
Remote work
Job Link Share:

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