RN Utilization Review - Lakewood - PT Days Exempt

University of California System • Lakewood, CA

179d

About The Position

The individual in this position is responsible for coordinating patient care activities to conform to evidence-based practice and/or regulatory/payor requirements. This position integrates functions typically considered to be case management, care coordination and/or utilization management, and discharge planning assessment.

Requirements

• Current CA RN license
• Conversant knowledge and experience with case management, care coordination, and/or utilization review
• Demonstrate the ability in collaborating with physicians
• Ability to lead and coordinate activities of a diverse group of people
• Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
• Must demonstrate customer service skills appropriate to the job
• Excellent written and verbal communication skills in English
• Ability to maintain a work pace appropriate to the workload
• Ability to establish and maintain effective working relationships across the Health System

Nice To Haves

• Knowledge of University and medical center organizations, policies, procedures and forms

Responsibilities

• Coordinating care
• Planning for discharge needs and arrangements, including leading multidisciplinary discharge planning teams and assessing patients for discharge planning needs
• Reviewing utilization patterns
• Referring complex social issues to social work
• Managing concurrent denials
• Coordinating weekly Complex Case Review
• Collecting clinical process and outcomes data, including Ecare
• Communicating with patients and their families around plan of care
• Assisting with physician documentation
• Arranging for patient education
• Communicating and collaborating with physicians, their office staff and staff of ancillary departments (e.g., lab, pharmacy)
• Assisting with ensuring accuracy of patient demographic and insurance information
• Assisting with making the appropriate referrals to other departments (e.g., PT/OT/ST)

Benefits

• Medical insurance
• Sick and vacation time
• Retirement savings plans
• Access to a number of discounts and perks

What This Job Offers

• Industry: Educational Services
• Education Level: Bachelor's degree