Utilization Review RN
Prime Healthcare Management Inc
Ontario, CA
- Eligibility
- Clinical Documentation & Utilization Review NursesAdministrative & Consulting Nurses
- Shift
- Days
Posted Jul 30 · Not open to new grads
What the listing says
Role
- Schedule
- Days
- Term
- Per Diem
- Setting
- Hospital
- Accepts
- RN
- Experience
- 3+ years
Ratio not posted. Ask in the interview.
Pay
- Against the board
- Below most CA PRN postings
CA PRN postings that state pay run $35/hr to $92/hr, the middle half $43/hr to $73/hr, across 510 postings.
About this role
Overview
Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one 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!
Read the full posting
Responsibilities
Responsible 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.
Qualifications
Education, experience, training
Required
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.
Pay Transparency
Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary.
A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $71,760.00 to $104,000.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Privacy Notice
Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf
Application details and notices
Employment Status: Full Time Shift: Days Equal Employment Opportunity
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/EEOC_KnowYourRights_screen_reader_10_20.pdf
Sourced from a public job board.
“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 mai” · from this posting
Requirements
- EDUCATION, EXPERIENCE, TRAINING
- 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.
Show all 9 requirementsShow fewer
- Experience and knowledge in basic to intermediate computer skills.
- Preferred qualifications: Five years acute care nursing experience preferred.
- Preferred qualifications: Experience with self-funded health plan preferred.
Place
- City
- Ontario, CA
- Median rent
- $2,030/mo
- Local household income
- $88,941/yr
- Metro price level
- 6% above the national average
rent and tenant-paid utilities · Census ACS 2024
all local households, not nurse pay · Census ACS 2024
Ontario area index 106.4, where 100 is the national average.
Ontario sits in California's Inland Empire, roughly 40 miles east of Los Angeles. The city blends suburban residential blocks with a major logistics economy anchored by Ontario International Airport. It's a practical home base for RNs seeking Southern California access without coastal-area density.
Cost figures from U.S. Bureau of Economic Analysis · 2024 metro Regional Price Parities · Census ACS 2024.
How this role fits you
On your path
Case Management is a specialty you move into. Bedside years first. That experience is what gets you in.
Worth asking
The posting doesn’t answer these. Good ones to ask a recruiter or in the interview.
- Can you walk me through differentials?
- What should I expect for weekly hours, weekend, holiday, call, and rotation?
- What orientation, preceptor time, and ongoing unit support are included?
- How are patient load, floating, and staffing support handled day to day?