Per Diem Registered Nurse II/III - Utilization Management VCMC

Ventura County • Ventura, CA

7d • Onsite

About The Position

Under direction, scheduled as needed to assist with patient care coordination and utilization review. The incumbent will be responsible for assisting in the evaluation of patient care data in order to coordinate post-discharge needs of patients. The Per Diem Nurse is distinguished from the Registered Nurse classification in that Per Diem Nurses are scheduled to work on an as-needed basis (intermittent) to supplement staffing needs. The ideal candidate will be compassionate and dedicated to providing the highest standard of care to patients. This position makes recommendations to physicians for alternate levels of care when the patient does not meet medical necessity for Inpatient hospitalization; interacts with the family, patient and other disciplines to coordinate a safe and acceptable discharge plan; functions as an indirect caregiver, patient advocate and manages patients in the most cost-effective way without compromising quality; transfers stable non-members to planned health care facilities; responsible for adhering to regulatory, accreditation, and compliance guidelines, as well as Post Stabilization notification. The incumbent must be able to work collaboratively with the multidisciplinary team and multitask in a fast-paced environment.

Requirements

• Six (6) months of recent acute care nursing experience in an acute hospital setting (for RN II)
• Five (5) years of recent acute care nursing experience in an acute hospital setting (for RN III)
• Graduation from an accredited School of Nursing
• Must possess and maintain a current valid license as a Registered Nurse issued by the State of California, or licensure in another state with California licensure pending
• Must have a current, valid Basic Life Support (BLS/CPR) certification by the first day of employment and maintain it thereafter
• Successful completion of the Health Care Agency Pharmacology examination within three (3) months of employment is mandatory

Nice To Haves

• Recent experience performing utilization review using MCG Care Guidelines to evaluate medical necessity and the appropriateness of patient treatment

Responsibilities

• Plans, develops, assesses and evaluates care provided to patients
• Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use
• Recommends alternative levels of care and ensures compliance with federal, state and local requirements
• Assesses high risk patients in need of post-hospital care planning
• Develops and coordinates the implementation of a discharge plan to meet patient's identified needs
• Communicates the plan to physicians, patients, family/caregivers, staff and appropriate community agencies
• Reviews, monitors, evaluates and coordinates the patient's hospital stay to assure that all appropriate and essential services are delivered timely and efficiently
• Participates in the Bed Huddles and carries out recommendations congruent with the patient's needs
• Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families
• Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient and non-KFH facilities
• Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred
• Refers patients to community resources to meet post hospital needs
• Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation
• Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: The Joint Commission (TJC), California Department of Health Services (DHCS), Centers for Medicare & Medicaid Services (CMS), and Department of Managed Health Care (DMHC)
• Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources
• Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness
• Reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities
• Reviews, analyzes and identifies utilization patterns, trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities
• Coordinates, participates and/or facilitates care planning rounds and patient family conferences as needed
• Participates in committees, teams or other work projects/duties as assigned
• Performs other duties as required

Benefits

• Educational Incentive: May be eligible for $1.25 an hour for a Bachelor's degree, or $1.75 an hour for Graduate’s degree not specifically required for the classification.
• Bilingual Incentive: Incumbents may also be eligible for bilingual incentives depending upon operational need and certification of skill.
• Certification Pay: $0.813 per hour based on scheduled work week hours for each qualified certification up to a maximum of five (5) certifications.
• Evening Shift Differential: 7.5%
• Night Shift Differential: 15%
• Weekend Shift Differential: $2.00 per hour
• Charge Nurse Premium Pay: $2.50 per hour
• Standby Premium Pay: ¼ of regular hourly wage or Federal minimum wage (whichever is greater)
• Overtime compensation

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level
• Education Level: No Education Listed