RN II-Case Management/ Utilization Review, Day Shift, Per Diem (CNA)

Adventist Health•San Luis Obispo, CA

3d•Onsite

About The Position

Adventist Health Sierra Vista is a 162-bed acute care facility on California’s Central Coast, with a Level III Neonatal Intensive Care Unit and a county-designated trauma center. The RN II in Case Management/Utilization Review assesses the appropriateness of admission status and level of care using InterQual criteria, provides discharge planning, and coordinates with patients, families, community agencies, payers, physicians, and other care team members. The role supports appropriate use of hospital resources and timely, high-quality patient care. The position has ten-hour day shifts, with an occasional weekend in rotation, and is represented by CNA.

Requirements

Associate degree (A.S.) or equivalent.
Three to five years of nursing experience in an acute care hospital setting.
Current RN license in the state of practice.
Basic Life Support (BLS) certification from an approved vendor per Adventist Health policy.
Basic computer skills, including Word, Excel, Outlook, and Internet navigation.

Nice To Haves

Bachelor’s degree in Nursing.
Recent experience in utilization review, discharge planning, and/or inpatient case management.
Knowledge of InterQual criteria and Medicare Conditions of Participation.

Responsibilities

Assess appropriateness of admission status and level of care using InterQual criteria, payer guidelines, and relevant documentation.
Assist physicians with admission decisions involving observation or inpatient status and review patient charts on the day of admission or the first day after admission for SI/IS.
Complete Advance Directive forms as needed and identify follow-up case management needs and opportunities for intervention.
Coordinate team or family conferences, contribute to patient care and teaching plans, and respond to issues that interfere with the plan of care.
Complete InterQual reviews and review care and progress for assigned patients as often as needed, at least every 72 hours, documenting progress in the computer system and patient chart.
Issue HABN letters as needed and refer cases that do not meet InterQual criteria to the UR advisor.
Provide appropriate medical information to insurers and government agencies to obtain optimal patient coverage; serve as liaison among payers, physicians, patients, families, and financial counselors.
Collaborate with team members to support reimbursement through essential documentation, document authorizations and denials, and proactively discuss appropriate inpatient testing with physicians.
Anticipate discharge needs, recommend referrals, and connect patients and families with resources within and outside the health care system and community.
Ensure patients are medically stable for discharge and that patients and families are prepared educationally, emotionally, and functionally.
Coordinate timely transfers to other facilities.
Accurately document case management needs, goals, and planned interventions in the patient record and hospital computer system.
Perform other job-related duties as assigned.