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    PR

    Prime Healthcare Management Inc.

    Healthcare

    Utilization Review RN

    Ontario, United StatesOn-SiteFull-time7+ yrs experience$71.8k – $104k / yearPosted 1mo ago
    All Prime Healthcare Management Inc. jobs

    Job description

    Overview

    Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

    Responsibilities

    Responsible for the quality and resource management of all authorizations and referrals with the Prime Healthcare Employee EPO. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the medical necessity, intensity of service and severity of illness.

    Qualifications

    EDUCATION, EXPERIENCE, TRAINING

    Required qualifications:

  1. Minimum 7 years Post Graduate of an accredited school of nursing and a current state Registered Nurse license.
  2. Minimum 3 years RN Utilization Manager working for a Health Plan.
  3. At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals.
  4. Current BCLS (AHA) certificate upon hire and maintain current.
  5. Knowledge of MCG Criteria and/or InterQual Criteria required.
  6. Experience and knowledge in basic to intermediate computer skills.
  7. Preferred qualifications:

  8. Five years acute care nursing experience preferred.
  9. Experience with self-funded health plan preferred.
  10. Pay Transparency

    Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.  Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary.  A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $71,760.00 to $104,000.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

    Employment Status

    Full Time

    Shift

    Days

    Equal Employment Opportunity

    Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

    Privacy Notice

    Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

    Job details are sourced from the employer's original posting.

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    PR

    About the company

    Prime Healthcare Management Inc.

    Prime Healthcare Management, Inc. is a diversified healthcare company that owns and operates hospitals and other healthcare facilities.

    View all Prime Healthcare Management Inc. jobs
    Industry
    Healthcare
    Open roles
    80

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