Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals.
On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country.
Job Summary
The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews. You will document decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings.
Job RequirementsMinimum Education Requirement :
Minimum Experience Requirement :Minimum of three years of utilization management experience. Experience in quality- related job preferred. Computer proficiency is required. Excellent customer service skills required.
Minimum License Requirement :California RN license.
Delivering world-class health care one patient at a time.
Pay Range:
$52.03 - $80.64Top Skills
What We Do
Emanate Health, www.emanatehealth.org, is the largest nonprofit health care provider serving the one million residents of the San Gabriel Valley in California. The system provides specialized care in Behavioral Health, Cancer, Cardiovascular, Emergency, Neuroscience and Stroke, Orthopedics, Sports Medicine, and Women’s Health. Its family includes Emanate Health Foothill Presbyterian in Glendora, Emanate Health Inter-Community in Covina, and Emanate Health Queen of the Valley in West Covina and Emanate Health Home Care in West Covina, as well as other clinics throughout the region. Year after year the health care system has been voted “Best Hospital” and “Best Place to Work” and our providers are consistently among the “Top Doctors” in Los Angeles County
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