Job Summary and Responsibilities
As our Utilization Review Nurse at the Utilization Management Hub, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision-making, regulatory compliance, and responsible resource utilization.
Every day you will meticulously review medical records, authorize services, and prepare cases for physician review in partnership with UM teams. You'll monitor patient care for appropriateness, quality, and cost-effectiveness, aligning decisions with established criteria.
To be successful in this role, you will possess a strong clinical background, deep UM/regulatory knowledge, and exceptional analytical/organizational skills. Your ability to manage charts, apply criteria precisely, and communicate effectively with enthusiasm, efficiency, and empathy is paramount for optimal patient care and operational flow.
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Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking. Reviews include admission, concurrent and post discharge for appropriate status determination.
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Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
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Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers.
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Ensures timely communication and follow upwith physicians, payers, Care Coordinators and other stakeholders regarding review outcomes.
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Collaborates with facility RN Care Coordinators to ensure progression of care.
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Engages the second level physician reviewer, internal or external, as indicated to support the appropriate status.
Job Requirements
Required:
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Graduate of an accredited school of nursing
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Registered Nurse with current California License required.
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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 required.
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Must be available to complete training on-site at Northridge Hospital.
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Every other weekend required.
Prefered:
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Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred.
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Knowledge of managed care and payer environment preferred.
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Must have critical thinking and problem-solving skills.
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Bachelor's Degree in Nursing (BSN) or related healthcare field Preferred.
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LA City Fire Card required within 90 days of hire.
Where You'll Work
Founded in 1955, Dignity Health - Northridge Hospital Medical Center is a 394-bed, acute care, nonprofit hospital located. Serving over 80,000 patients annually, the hospital offers a full complement of services including a Level II Trauma Center, heart care, cancer care and women's health. It is the only pediatric trauma center in the San Fernando Valley.
Additionally, Northridge Hospital Medical Center has been recognized as an LGBTQ+ Healthcare Equality High Performer by the Human Rights Campaign Foundation. It is a Joint Commission-certified Thrombectomy-Capable Stroke Center and has been recognized as one of America's 50 Best Hospitals by Healthgrades in 2026.
One Community. One Mission. One California (https://youtu.be/RrPuiSnALJY?si=pvQgPZ6ZWZM60TPV)
Pay Range
$55.55 - $79.06 /hour
We are an equal opportunity employer.
