Senior Registered Nurse - Utilization Management

Ventura County•Ventura, CA

3d•Onsite

About The Position

Under general direction and following established medically approved policies and procedures, the incumbent implements specialized skilled nursing processes in designated hospital units of Ventura County Medical Center and Santa Paula Hospital. The Senior Registered Nurse-Hospital works collaboratively with a medical doctor to coordinate and screen for the appropriateness of admissions and continued stays. They make recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for inpatient hospitalization. They interact with the family, patients, and other disciplines to coordinate a safe and acceptable discharge plan. They function as an indirect caregiver, patient advocate, and manage patients in the most cost-effective way without compromising quality. They will also be responsible for complying with AB 1203, Post Stabilization notification. AGENCY/DEPARTMENT: Health Care Agency – Ventura County Medical Center and/or Santa Paula Hospital PAYROLL TITLE: Senior Registered Nurse-Hospital Senior Registered Nurse-Hospital is represented by the California Nurses' Association (CNA) and is eligible for overtime compensation. Salary placement will be determined according to the current CNA memorandum of agreement. The eligible list established from this recruitment may be used to fill current and future Regular (including Temporary and Fixed-term), Intermittent, and Extra Help vacancies. There is currently one (1) Regular vacancy.

Requirements

Two (2) years of full-time professional registered nurse experience, including two (2) years in an acute care setting.
Must possess and maintain a current, valid license as a Registered Nurse issued by the State of California.
Must have a current, valid Basic Life Support (BLS/CPR) certification by first day of employment.
Must be able to work collaboratively with the multidisciplinary team, multitask and work in a fast-paced environment.

Nice To Haves

Knowledge of principles, practices, and techniques of utilization management, utilization review, discharge planning, care coordination, and case management in an acute care setting.
Knowledge of applicable federal, state, local, regulatory, and accreditation requirements related to healthcare delivery, patient care, utilization management, and discharge planning, including Medicare, Medi-Cal, and Joint Commission standards.
Knowledge of nursing principles, clinical assessment methods, and standards of patient care applicable to acute care and hospital settings.
Knowledge of community resources, post-acute care services, referral processes, and continuity of care practices.
Knowledge of quality management, patient safety, risk management, and performance improvement principles and practices.
Knowledge of methods and techniques used in patient, family, and staff education.
Skill in assessing, evaluating, and coordinating patient care needs and appropriate levels of care.
Skill in interpreting and applying clinical guidelines, medical necessity criteria, policies, procedures, and regulatory requirements.
Skill in utilizing electronic medical records, healthcare information systems, and standard office software applications.
Ability to collaborate effectively with physicians, multidisciplinary healthcare teams, patients, families, caregivers, community agencies, and outside providers.
Ability to analyze clinical information, identify utilization trends or concerns, and make sound recommendations regarding patient care and resource utilization.
Ability to communicate effectively both orally and in writing, including explaining complex medical and discharge planning information to diverse audiences.
Ability to organize, prioritize, and coordinate multiple assignments in a fast-paced healthcare environment while maintaining accuracy and attention to detail.
Ability to exercise sound judgment, maintain confidentiality, and respond effectively in stressful, sensitive, or emergency situations.

Responsibilities

Plans, develops, assesses, evaluates, and coordinates care provided to patients/members to ensure quality, continuity, and appropriate resource utilization.
Collaborates with physicians, multidisciplinary healthcare teams, patients, families, caregivers, and community agencies in the development, implementation, and documentation of individualized plans of care.
Conducts utilization management and quality management reviews for patients in outpatient, emergency room, inpatient, and other healthcare settings using established guidelines and standards.
Reviews, monitors, evaluates, and coordinates patient care and hospital stays to ensure appropriate, timely, and efficient delivery of services.
Assesses high-risk patients and develops, coordinates, and implements discharge and post-hospital care plans to meet identified patient needs.
Coordinates interdisciplinary care planning activities, patient family conferences, bed huddles, transfer coordination, discharge planning activities, and continuity of care services.
Coordinates transfers and referrals to appropriate facilities, providers, and community resources, including obtaining required authorizations and maintaining required documentation.
Acts as a liaison between healthcare facilities, referral agencies, providers, patients, and families regarding care coordination and case management activities.
Recommends alternative levels of care and ensures compliance with applicable federal, state, local, regulatory, accreditation, and organizational requirements.
Educates healthcare team members regarding discharge planning processes, resource utilization, care coordination practices, and related responsibilities.
Provides patients and families with education and support regarding discharge planning, post-hospital care, and coping with acute or chronic illnesses.
Identifies, reports, and documents unusual occurrences, quality concerns, patient safety issues, risk management concerns, and inappropriate utilization of resources in accordance with established protocols.
Reviews, analyzes, and monitors utilization patterns, trends, and data to support studies, projects, planning activities, and routine utilization monitoring functions.
Participates in committees, teams, care planning activities, special projects, and other related duties as assigned.
Performs other related duties as required.