Utilization Management RN - Per Diem

UHS•Fremont, CA

About The Position

Come join our team and love what you do! We are currently hiring a per diem Utilization Management RN for Fremont Hospital! The Utilization Management RN is responsible for but not limited to the facilitation of pre-authorization, verification of benefits prior and/or during admission, clinically pertinent reviews on patient admissions for continued stay reviews including completion of certifications. The Utilization Management RN will interface with managed care organizations, external reviewers and other payers to ensure that the admission, continued stay, and discharge plan is in compliance with TJC, HCFA, and established utilization management policies and procedures. On-going discharge planning documentation will be audited by the UM /Discharge planning staff with follow-up/coordination with the appropriate disciplines. Commuting to Fremont Hospital is easy! It is convienently located near public transportation options such as AC Transit, BART, and the ACE Train. Fremont Hospital offers comprehensive benefits for the per diem Utilization Management RN position, such as: Challenging and rewarding work environment Competitive compensation Tuition assistance Career development opportunities across UHS and our 300+ locations! HealthStream online learning catalogue with plenty of free CEU courses Competitive compensation & generous paid time off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan Pet insurance SoFi Student Loan Refinancing Program More information is available on our Benefits Guest Website: uhsguest.com Fremont Hospital is a fully accredited, 148-bed private inpatient psychiatric hospital providing quality care for children through adults. The facility provides a full assortment of care which includes assessments, inpatient psychiatric hospitalization, partial-hospitalization, intensive outpatient psychiatric treatment as well as chemical dependency outpatient care. About UHS: One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $11.6 billion in 2020. In 2021, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; in 2020, ranked #281 on the Fortune 500; and listed #330 in Forbes ranking of U.S.’ Largest Public Companies. Headquartered in King of Prussia, PA, UHS has 89,000 employees and through its subsidiaries operates 26 acute care hospitals, 334 behavioral health facilities, 39 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 38 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.

Requirements

Graduation from an accredited clinical program in Nursing. Bachelor’s Degree preferred.
Minimum of 2 years direct clinical experience in a health care setting. Requires experience and/or utilization management, managed care or a related role.
RN in state of California.
Strong communication, problem-solving and analytical skills. Basic computer skills.
Ability to work closely and effectively with physicians, patient/families, hospital staff, co-workers, and the community.
Ability to assess patient needs based on age, physical and psychosocial need.
Must be well versed in understanding the facilitation of patients through the continuum of care process and have a good degree of assertiveness in/or to actively advocate for the patient(s).
Successful completion of CPR Certification.
Successful completion of Crisis Preventative Intervention (CPI) course at Fremont Hospital within 90 days of employment and prior to assisting with restraining procedures.
Able to work overtime and flexible hours if required.

Responsibilities

facilitation of pre-authorization
verification of benefits prior and/or during admission
clinically pertinent reviews on patient admissions for continued stay reviews including completion of certifications
interface with managed care organizations, external reviewers and other payers to ensure that the admission, continued stay, and discharge plan is in compliance with TJC, HCFA, and established utilization management policies and procedures
On-going discharge planning documentation will be audited by the UM /Discharge planning staff with follow-up/coordination with the appropriate disciplines