Tenet Healthcare Corporation·Modesto, California
The Utilization Review Nurse ensures patients are admitted to the appropriate level of care according to regulatory guidelines and facility goals. They coordinate authorizations for acute hospitalizations and act as a liaison between medical staff and external review organizations.
Job Type: Per Diem
Job Shift: Rotate
Department: Behavioral Health
Reporting to the Director of Case Management, the Utilization Review Nurse is responsible for ensuring that patients being admitted to Doctors Behavioral Health Center are admitted to the appropriate level of care in accordance with the vision and goals of Doctors Medical Center and the regulatory guidelines as set by the state and federal rules. The Utilization Review Nurse ensures quality, cost-effective patient care through planning; communication, critical thinking and facilitation of the multi-disciplinary patient care team. Coordinates Utilization Review activities to ensure that authorizations are obtained for in-patient acute hospitalizations. Acts as a liaison between MD’s, the Treatment Team and External Review Organizations. Reviews the Treatment Plan and monitors the delivery of care to make sure the desired treatment outcomes are achieved.. Communicates reimbursement issues, trends and patterns to the Director of Case Management and the Administrator.
Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients' lives while enjoying a supportive work environment that fosters professional growth and work-life balance. Ready to be a vital part of our mission? Apply today and bring your passion for nursing to a place where it truly matters!
Note: Eligibility for benefits may vary by location and is determined by employment status
Doctors Medical Center (DMC), part of the Central Valley Doctors Health System, is the largest full-care hospital between Stockton and Fresno, and from the Sierras to the San Francisco Bay Area, with a 394-bed general acute care and a 67-bed inpatient psychiatric capacity. DMC is known for providing comprehensive inpatient, outpatient and emergency care. Doctors Medical Center offers a wide range of services including cardiology, neurosurgery, orthopedics, emergency and trauma services, minimally-invasive and robotic surgery, women and childrens services, medical/surgical, behavioral health, oncology and critical/intensive care. Join our team!
Candidates must hold a current California Registered Nurse license and BLS certification, with a BSN preferred. A minimum of one year of experience in acute hospital settings and one year in inpatient psychiatric or chemical dependency care is required.
Market context
In California, behavioral-health roles tied to substance use disorder counseling and case management are typically supported by ongoing community and treatment-program demand. These positions are competitive because employers often look for a high school diploma, at least 2 years of SUD counseling or case management experience, and current Registered or Certified Drug and Alcohol Counselor status. Review the AI-summarized requirements and benefits here to quickly compare fit and note that professional development and paid continuing education are listed as benefits.