Utilization Review Nurse - Full Time
Full-time
Bakersfield, CA, USA
Posted on Oct 4, 2026
Role: Utilization Review Nurse, responsible for implementing hospital utilization review and discharge planning programs.
Key Duties: Obtain and evaluate medical records to assess inpatient admissions, conduct ongoing care reviews, develop discharge plans, coordinate with hospital services and external agencies, and ensure appropriate reimbursement and compliance with regulations. Review and approve surgical schedules, manage pay source issues, and educate providers on documentation requirements to maximize reimbursement.
Qualifications: Valid California RN license with two years of acute care or utilization/discharge planning experience. Knowledge of payor documentation, healthcare regulations, patient care processes, and hospital operations. Ability to evaluate medical records, communicate effectively with providers, and analyze data for reporting.
Skills: Strong clinical assessment, regulatory knowledge, communication, and collaboration skills. Must maintain BLS certification and adhere to professional standards.
Additional: May be required to undergo background checks and possess a valid California driver’s license if driving is necessary.
Key Duties: Obtain and evaluate medical records to assess inpatient admissions, conduct ongoing care reviews, develop discharge plans, coordinate with hospital services and external agencies, and ensure appropriate reimbursement and compliance with regulations. Review and approve surgical schedules, manage pay source issues, and educate providers on documentation requirements to maximize reimbursement.
Qualifications: Valid California RN license with two years of acute care or utilization/discharge planning experience. Knowledge of payor documentation, healthcare regulations, patient care processes, and hospital operations. Ability to evaluate medical records, communicate effectively with providers, and analyze data for reporting.
Skills: Strong clinical assessment, regulatory knowledge, communication, and collaboration skills. Must maintain BLS certification and adhere to professional standards.
Additional: May be required to undergo background checks and possess a valid California driver’s license if driving is necessary.