Utilization Review Program Coordinator RN jobs in United States
cer-icon
Apply on Employer Site
company-logo

Valley Children's Healthcare · 14 hours ago

Utilization Review Program Coordinator RN

positionMadera, CA
timeFull-time
remoteOnsite
senioritySenior Level
money$53/hr - $82/hr
date5+ years exp

Valley Children's Healthcare is seeking a Utilization Review Nurse Coordinator to oversee the Utilization Management program. The role involves reviewing services for appropriateness, managing hospital resources, and ensuring compliance with regulations to enhance healthcare delivery.

Health CareHealth DiagnosticsHospitalMedicalWellness

Responsibilities

Oversee the Utilization Management (U.M.) program
Review and screen the appropriateness of services
Utilization of hospital resources
Quality of patient care rendered
Reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided
Facilitate the quality of health care delivery in the most cost effective manner
Ensure compliance with all regulations related to Utilization Management
Develop quarterly reports for the U.M. Medical Director for presentation at Pharmacy Therapeutics & Utilization (PT&U) committee
Facilitate UM subcommittee meetings

Qualification

RN - Reg NurseUtilization Management knowledgePediatric experienceCase Management experienceComputer SkillsProficiency with softwareOrganizational skillsCommunication skillsWork independently

Required

College Degree - 2 year Nursing
RN - Reg Nurse
Minimum five (5) years Full time equivalent RN experience in an acute care hospital

Preferred

College Degree - 4 year Nursing or related field
Pediatric experience and experience in Case Management and/or Utilization Review
Computer Skills
Knowledge of UM regulations
Knowledge of private and public payer reimbursement practices and procedures
Excellent organizational and communication skills and ability to work with a variety of health care professionals
Ability to work independently
Computer Skills Proficiency with word processing, spreadsheets and database software

Company

Valley Children's Healthcare

twittertwittertwitter
company-logo
Valley Children's Healthcare is a healthcare provider that specializes in pediatrics, children's healthcare treatments, and services.
dateFounded in 1952
location
Madera, California, USA
people-size1001-5000 employees
web-link
https://www.valleychildrens.org/

Funding

Current Stage
Late Stage
Total Funding
unknown
Key Investors
Baldrick's Foundation
2023-11-21Grant

Leadership Team

leader-logo
Todd Suntrapak
President and CEO
linkedin

Recent News

Valley Children’s Healthcare
Valley Children’s Healthcare Becomes Exclusive Healthcare Partner of CIF Central Section
2025-10-10
PR Newswire
Honoring organ donors and inspiring hope for those waiting for transplants, the Fresno Stride for Hope Run/Walk returns Saturday, Sept. 20
2025-09-19
Baltimore Sun
Nonprofit hospitals spend millions on stadium naming rights, raising eyebrows
2025-08-14
Company data provided by crunchbase