Utilization Mgmt RN

Madera, California, 93636 Job Summary: The Utilization Management Nurse supports the case management department by providing a variety of utilization management functions including but not limited to daily screening of patient admission relative to specified criteria, active involvement in denial management, acting as a resource to staff regarding clinical criteria, communication with payors to address concerns and other duties as assigned. The Utilization Management Nurse will work collaboratively with the Utilization Nurse Program Coordinator to ensure compliance with regulatory, organizational and department requirements. The Utilization Review Nurse will receive direction from the Utilization Review Program Coordinator for daily and long term tasks and projects. Qualifications: Education Associates Degree Nursing (required) Bachelors Degree Nursing or related field (preferred) Licenses and Certifications RN - Registered Nurse License - CA-BRN - California Board of Registered Nursing (required) Work Experience Minimum three (3) years Full time equivalent RN experience in an acute care hospital. (required) Pediatric experience and experience in Case Management and/or Utilization Review. (preferred) Skills and Abilities 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. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Compensation Range: $53.00 - $82.00 Workshift: Day (United States of America) Position Exempt: No FTE %: 50 Scheduled Weekly Hours: 20 Daily Hours: 8 Have Questions? Call Recruitment Services at 559-353-7071 or email us at recruiting@ Disclaimer: Final compensation will be dependent upon skills and experience. ABOUT VALLEY CHILDREN S HOSPITAL: Based in Madera, CA, and ranked by U.S. News & World Report as one of the best children's hospitals in the country in seven pediatric specialties and has been open for 70 years.  It has grown from a 42-bed hospital to one of the largest pediatric healthcare networks in the Country. With hospitals and clinics located from Sacramento to San Luis Obispo, you are sure to find an opportunity that fits your lifestyle. Valley Children's maintains a family-like atmosphere to more than 3,000 employees and recognizes that employees play an important role in the success of the entire organization, so employees and their families are rewarded with robust benefits.  Valley Children's is proud to have dedicated staff committed to the highest quality of pediatric care. From the moment you enter the doors, you will feel at home. They have a strong presence in the community and tremendous pride for the care they deliver. Many Valley Children's employees have been with the organization for over 10 years while others more than 30 years and they continue to grow their career through supported professional growth and development. Valley Children's main campus sits in the heart of one of the most beautiful states in the nation, just a short drive from three national parks and your choice of California coastline beaches. No matter your interest, you will have many opportunities for recreation, arts, entertainment, and more.

Created: 2026-03-04