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Utilization Management Nurse RN

Utilization Management Nurse RN
Date: 10/31/2014

Description: Under direction of the Kern Health Systems (KHS) Medical Director and Director of Health Services, the Utilization Management Nurse, RN, is responsible for clinical review for members receiving care in an inpatient setting.  Reviews the appropriateness and medical necessity of admissions and continuing inpatient confinement utilizing Milliman and Medicaid criteria.  Makes first level approval determinations and appropriately refers cases to the Medical Director for second review when case does not meet criteria.

Incumbents in this position are fully competent in all essential areas of utilization management and are expected to use an advanced level of judgment in the discharge of their duties.  Utilization Management Nurses work independently under general direction. This position involves frequent communication with members, caregivers, medical providers, and KHS staff telephonically, electronically and potentially in-person.  UM Nurses may be assigned at on-site facilities or may work at KHS Offices.


: Minimum of two years (2) full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required.  Experience working with patients and caregivers regarding self-care and disease management required.  Experience working in case management or care coordination is a plus. Knowledge of Kern County Community resources for seniors and people with disabilities is a plus. Bachelor’s Degree from an accredited school or equivalent in Nursing, Health Administration or related healthcare field preferred. California Nurse Practitioner license a plus.  Registered Nurse with an active, current, unrestricted license. Valid California Driver License. Bilingual (English/Spanish) preferred.

We have an excellent benefit package to include: health care, dental, life, 457b and 401a plan, and other supplemental benefits.  As a condition of employment, a satisfactory drug test and background check are required. E.O.E.

Req# 187-14