About Us:

Creating Health and Harmony, Southwest Healthcare is a comprehensive network of care with convenient hospital and ambulatory care/outpatient locations here to serve the Southern California community. With over 6,000 passionate providers and healthcare employees, our shared goal is to provide convenient access to a wide range of healthcare services in a way that benefits you, your family, and the entire community.

Southwest Healthcare is comprised of five acute care hospitals and several non-hospital access points, including: Corona Regional Medical Center, Palmdale Regional Medical Center, Southwest Healthcare Rancho Springs Hospital, Southwest Healthcare Inland Valley Hospital and Temecula Valley Hospital, Temecula Valley Day Surgery, A+ Urgent Care Centers, and Riverside Medical Clinics. For more information, please visit our website at www.swhealthcaresystem.com.

Job Summary:

The Southwest Healthcare Regional office is seeking a System Manager of Central Utilization Review. This position will serves as an interdisciplinary team member to coordinate the delivery of healthcare services leading to quality outcomes for the hospital population and their families within the limits of the financial and social resources available. Duties include but not limited to:

• Manages all aspects of the Centralized UR Department, ensuring compliance with policies and procedures and that quality of care is consistent with regulatory standards.
• Subject expert on issues related to utilization review, utilization management, and transitions of care.
• Performs and conducts quality review of utilization review functions for appropriateness of observation, admission, and continued hospital stays.
• Analyzes utilization of healthcare resources through concurrent review and retrospective studies. Identifies and records avoidable days.
• Up to 50% of travel time between facilities in Southern California.

• Bachelor's degree in Nursing from an accredited College or University required. Master's degree from an accredited College or University in a related field preferred.
• Three (3) to Five (5) years of clinical experience in Case Management/Utilization required.
• Minimum three (3) years leadership experience in Case Management/Utilization Review required, Healthcare experience preferred.

Certifications/Licenses:

• Current license as a Registered Nurse in the State of California required.
• Current Basic Life Support (BLS) or CPR Certification through the American Heart Association. Must be obtained within 90 days of start date required.
• Current CA Drivers' License required.
• CCM or ACM certification preferred.

Other Skills and Abilities:

• Demonstrates knowledge and ensures compliance with the Nurse Practice Act, The Joint Commission regulatory guidelines, Title 22 standards and guidelines, and CMS Conditions of Participation.
• Demonstrates compliance with hospital policies and procedures at all times.
• Demonstrates strong leadership, organization, communication, and interpersonal skills.
• Demonstrates ability to relate to clinical personnel and medical staff, as well as ability to interact well with the public.
• Must have knowledge of PC and applications.
• Knowledgeable in Interqual guidelines, MCG, and 2 Midnight Rule.
• Knowledgeable in Medi-cal TAR program requirements.
• Capable of resolving escalated issues arising from operations and requiring coordination with other.

• Challenging and rewarding work environment.
• Competitive Compensation & Generous Paid Time Off.
• Excellent Medical, Dental, Vision and Prescription Drug Plans.
• 401(K) with company match and discounted stock plan.
• SoFi Student Loan Refinancing Program.
• Tuition, CEU, Certification, Licenses Reimbursement program.
• Career development opportunities within UHS and its 300+ Subsidiaries!