OverviewPrime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOCKnowYourRightsscreenreader1020.pdf ResponsibilitiesResponsible for the quality and resource management of all authorizations and referrals with the Prime Healthcare Employee EPO. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the medical necessity, intensity of service and severity of illness.QualificationsEDUCATION, EXPERIENCE, TRAININGRequired qualifications:
Minimum 7 years Post Graduate of an accredited school of nursing and a current state Registered Nurse license.
Minimum 3 years RN Utilization Manager working for a Health Plan.
At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals.
Current BCLS (AHA) certificate upon hire and maintain current.
Knowledge of MCG Criteria and/or InterQual Criteria required.
Experience and knowledge in basic to intermediate computer skills.
Preferred qualifications:
Five years acute care nursing experience preferred.
Experience with self-funded health plan preferred.
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FacilityPrime Healthcare Management IncLocationUS-IL-AuroraID2024-186099CategoryRNPosition TypeFull TimeShiftDaysJob TypeExempt