Description

<span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;"><strong>Direct Hire + Hybrid! 100% Employer Paid Benefits! Professional Development/Tuition Reimbursement, look no further for your RN Utilization Manager Opportunity!</strong><br><br><strong>Job Title:</strong> RN Utilization Manager (Hybrid)<br><strong>Location:</strong> Palm Springs, CA<br><strong>Employment Type:</strong> Direct Hire<br><strong>Schedule:</strong> M–F - 8AM–5PM<br><strong>Salary:</strong> $123,968/yr<br><br><strong>Overview:</strong><br>We’re hiring an <strong>RN Referrals Manager/Utilization Manager</strong> to lead a high-volume referrals department. This is a newly established leadership role supporting referral processing, regulatory compliance, and performance management, with <strong>11 direct reports</strong> plus <strong>offshore referral coordinators</strong>.<br><br><strong>Key Responsibilities for RN Utilization Manager:</strong></span></span><ul><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;">Provide daily oversight of the <strong>Referral Department</strong> (workflow, quality, turnaround times)</span></span><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;">Ensure compliance with applicable regulatory and health plan requirements</span></span><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;">Coach, train, and develop staff; monitor productivity and performance trends</span></span><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;">Support audits (CMS/DMHC/DHCS/Health Plan) and corrective action plans</span></span><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;">Serve as the <strong>clinical resource</strong> for referral processing and peer-to-peer coordination</span></span><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;">Partner with medical leadership and senior directors to improve processes and documentation</span></span></ul><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;"> <strong>Required Qualifications for RN Utilization Manager:</strong></span></span><ul><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;"><strong>Active California RN license</strong></span></span><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;"><strong>Bachelor’s Degree in Nursing (BSN) required</strong> (Master’s preferred)</span></span><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;"><strong>3+ years</strong> RN experience in <strong>Utilization Review/Compliance Review/Acute Care/ER</strong></span></span><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;"><strong>3+ years</strong> in a S<strong>upervisory/Managerial</strong> role</span></span><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;">Strong knowledge of clinical criteria and documentation standards; familiarity with diagnosis/procedure coding practices</span></span></ul><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;"> <strong>100% Paid Benefits:</strong></span></span><ul><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;"><strong>Medical insurance at no cost to employee</strong> (employer covered)</span></span><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;"><strong>No-cost pharmacy benefit</strong> (employee)</span></span><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;">Dental, Vision, EAP, Life/AD&D, LTD options</span></span><li style="margin: 0.0in 0.0in 8.0pt;"><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;">401(k) with company match; PTO (released after 90-day evaluation)</span></span></ul><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;"> <strong>Referral Bonus (MediQuest):</strong><br>Referrals really pay off. Do you know someone in healthcare looking for work? Refer them to MediQuest and earn up to $500 per referral, depending on the type of position they accept.</span></span><ul><li><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;">No limit to the number of referrals you provide or the amount you can earn</span></span><li><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;">Anyone can earn a referral bonus - not just MediQuest candidates </span></span></ul><span style="font-family: Trebuchet MS , Helvetica , sans-serif;"><span style="font-size: 14.0px;"> <strong>About MediQuest:</strong><br>MediQuest matches high-quality healthcare professionals with talented medical support staff. Our dedicated medical focus and expertise allow us to build collaborative partnerships with both clients and candidates, ultimately creating lasting value and delivering performance-based results in the constantly evolving healthcare industry. We have been connecting candidates with private practices, outpatient clinics, hospitals, independent physicians’ associations, medical billing services, urgent care, and healthcare administration since 1965. We know that it takes great people to make a great company.</span></span>PandoLogic. Keywords: Utilization Review Nurse, Location: Desert Hot Springs, CA - 92241