Valley Children’s Healthcare·Madera, California
The Utilization Management Nurse performs daily patient admission screenings and manages denials based on specified clinical criteria. They collaborate with the Program Coordinator to ensure regulatory compliance and act as a clinical resource for staff and payors.
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.
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.
$57.29 - $81.72
Workshift: Day (United States of America)
FTE %: 90
Scheduled Weekly Hours: 36
Daily Hours: 8
Have Questions?
Call Recruitment Services at 559-353-7071 or email us at recruiting@valleychildrens.org Disclaimer: Final compensation will be dependent upon skills and experience.
Candidates must have an Associate's Degree in Nursing, a valid California RN license, and at least three years of acute care hospital experience. A Bachelor's degree and experience in pediatrics or case management are preferred.
Market context
California nursing roles often draw steady demand, especially for experienced RNs in procedural and critical care settings. Competition is strongest for candidates who already hold a California RN license, current BLS and ACLS, and recent ICU, ER, or PACU experience. Review the AI-summarized requirements and benefits on this platform to save research time, then confirm your certifications and highlight relevant bedside and procedural experience in your application.
