Utilization Review Nurse Supervisor II

About This Role

This role involves exercising administrative and technical supervision over nursing staff engaged in utilization review activities at Los Angeles General Medical Center. The position is responsible for directing activities, developing procedures, and ensuring compliance with utilization review standards to ascertain medical necessity and appropriate level of care for patients.

Responsibilities

• Plan, develop, and implement procedures to fulfill Professional Standards Review organization requirements for an effective utilization review system.
• Direct the utilization review function through subordinate supervisors, conferring on personnel, technical, and administrative problems.
• Review and analyze reports prepared by subordinate supervisors to identify areas for improvement in procedures or staff training.
• Determine the need for and conduct in-service training to improve quality of admission and continued stay reviews.
• Evaluate the performance of subordinate supervisors and review their evaluations of Utilization Review Nurses.
• Develop procedures for compiling information from medical charts for medical care evaluation studies.
• Work with Professional Standards Review Organization representatives to orient new staff to Federal laws and regulations.
• Confer with physicians, administrative personnel, and other disciplines to coordinate unit work and develop review procedures.
• Attend Utilization Review Committee meetings to inform on new/revised utilization review requirements and implement procedures for compliance.

Requirements

• 1 year of supervisory experience in utilization review nursing within the last 5 years
• Current Registered Nurse license issued by the California Board of Registered Nursing
• Current BLS for Healthcare Providers certification from American Heart Association

Qualifications

• One (1) year experience within the last five (5) years in the supervision of nursing staff engaged in utilization review activities, including planning, assigning, reviewing work, and evaluating employee performance.

Nice to Have

• Experience within the last five (5) years in the supervision of nursing staff engaged in utilization review activities beyond the selection requirements
• Bachelor of Science degree in Nursing (BSN) or higher from an accredited institution

Certifications