Utilization Review RN

St. Elizabeth Community Hospital provides state-of-the-art health care to the North State communities. This award-winning facility is a member of the Dignity Health system of health care providers and is a not-for-profit medical center. Located in picturesque Tehama County, St. Elizabeth offers 76 licensed beds, a trauma level III emergency department, comprehensive surgical services and a progressive Family Birth Center. St. Elizabeth Community Hospital has earned a Grade "A" from The Leapfrog Group for quality and safety for six consecutive award periods, and has built a reputation for excellence in orthopedics, family-centered maternity care and emergency services. St. Elizabeth is a sister facility to Mercy Medical Center Redding and Mercy Medical Center Mt. Shasta, and is committed to providing the highest quality, compassionate care available. For more information visit here https://www.dignityhealth.org/north-state/locations/stelizabethhospital.

One Community. One Mission. One California 

Position Summary:

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.

Minimum Qualifications:

• Required

  • 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

Preferred Qualifications:

• • 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
  • Able to apply clinical guidelines to ensure progression of care.
  • 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.