UM/QI/Capitation Nurse (RN) - Utilization Management

This is a fulltime authorization nurse, experience with health plan authorization process is strongly preferred.

May be considered a hybrid position

JOB SUMMARY:

Under the supervision of the Supervisor, UM Clinical, the Utilization/Case Manager Nurse coordinates the delivery of care through assessment, planning, facilitation, & patient advocacy to ensure cost-effective, quality outcomes of care. The Utilization/Case Manager Nurse works with all members of the health care team to ensure optimal outcomes are reached while appropriate utilization occurs

MINIMUM QUALIFICATIONS:

Associate’s Degree

3 years of experience

California RN License

Knowledge of common medical insurance operations

Managed Care experience (will consider Hospital Case Management Experience)

Strong mathematical and reasoning skills

PREFERRED QUALIFICATIONS:

Bachelor’s Degree

Pediatric Nursing Experience

The current salary range for this position is $45.75 to $62.90

Rady Children’s Hospital is committed to compensation that is externally competitive and internally equitable. We demonstrate this commitment by conducting regular market reviews to remain competitive with organizations of similar size in the nonprofit, healthcare sector. The range listed above does not represent the full salary range for the position but is the expected hiring range for qualified candidates. Compensation decisions consider a variety of factors including experience, education, licensure, unique skillsets, organizational need, and internal equity. This posting will remain open from the “date posted” until the hiring manager has determined there is a sufficient applicant pool or until the position is filled.