Coordinator - Utilization Review - Social Work

Desert Valley Hospital•Victorville, CA

About The Position

Desert Valley Hospital is an accredited 148-bed acute care hospital located in Southern California. Desert Valley Hospital is in the top 5% of more than 4,500 hospitals nationwide for clinical performance. The hospital has achieved numerous quality award distinctions including Patient Safety Excellence Award, Women’s Health Excellence Award and Distinguished Hospital Clinical Excellence Award. Desert Valley Hospital, along with Desert Valley Medical Group, offers key services to the community including heart care, emergency services, labor and delivery, surgical services and more. For more information visit www.DesertValleyHospital.com. Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Why Prime Healthcare? Desert Valley Hospital, a member of the Prime Healthcare Foundation, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. Desert Valley Hospital offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to: Paid Time Off 401K retirement plan Outstanding Medical Dental Vision Coverage Tuition Reimbursement Many more Voluntary Benefit Options! Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time. This is a Fast-paced work environment in which you can take pride in serving an underserved community. Come Join a Team of Dedicated Healthcare Workers!!!

Requirements

Knowledge of Utilization Management/Case Management terminology and functions, in both Managed Care and Non-Managed Care environments.
At least one year of experience as a Case Manager in an acute care setting or related field and coding chart review for meeting criteria purposes.
Basic to intermediate computer knowledge.
Must have a valid RN/LVN California License.

Responsibilities

Coordinates interviews and reviews all medical records, as assigned to caseload.
Actively participates in Case Management and Committee Team meetings.
Responsible for reviewing patient medical information from medical records and various sources in order to assess, identify, plan, monitor, develop, and coordinate appropriate, cost effective care for all the PMG/IPA capitated members that present significant medical risks/liabilities, in the ambulatory and institutional settings.
The scope of the program includes, but is not limited to: acute inpatients/ambulatory i.e. catastrophic cases, chronic cases, transplant/aids cases, institutionalized cases and any member requiring continuity and , ,coordination of care, transition of medical care from one setting to another, behavioral health care, or community resources.
Able to work independently and use sound judgment.
Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.
Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients and families, Interdisciplinary Care Team and all other committees as appropriate.