The Utilization Management (UM) RN performs utilization review activities, including, but not limited to, precertification, ensures appropriate level of care and status (Inpatient, Outpatient, and Observation) throughout admission and performs initial reviews, concurrent reviews, and retrospective reviews according to guidelines. Determines the medical necessity of requests by performing first level reviews. The UM nurse ensures a process that is efficient for providing care, ensuring timely and appropriate levels of care for the incoming patients. UM RN is responsible for preparing cases for Physician Advisor for 2nd level review. UM RN delegates accordingly to LVN and works in conjunction with a multi-disciplinary team to manage the care of patients in an ethical and fiduciary responsible manner.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.