Utilization Review Registered Nurse (on site) - Mental Health 194

Telecare • Santa Cruz, CA

117d • $70 - $86

About The Position

The Utilization Review (UR) Nurse works collaboratively with the county or customer utilization and the treatment team to ensure that the care provided is appropriate and medically necessary. The UR Nurse also ensures that medical record documentation explains the care provided as well as the members served response to treatment. The UR Nurse will support programs as assigned and attend treatment team meetings.

Requirements

• Graduation from an accredited Registered Nursing Program (RN)
• Two (2) years of inpatient psychiatric nursing experience
• Current RN State license
• Current BLS certification
• Must be at least 18 years of age
• Must be CPR, First Aid, and CPI certified (hands-on course) on date of employment or prior to providing direct client care and maintain current certification throughout employment
• All opportunities at Telecare are contingent upon successful completion and receipt of acceptable results of the applicable post-offer physical examination, 2-step PPD test for tuberculosis, acceptable criminal background clearances, excluded party sanctions, and degree or license verification
• If the position requires driving, valid driver's license, a motor vehicle clearance and proof of auto insurance is required at time of employment and must be maintained throughout employment

Nice To Haves

• Utilization Review Nurse experience preferred

Responsibilities

• Demonstrates the Telecare mission, purpose, values, and beliefs in everyday language and contact with the internal and external stakeholders
• Reviews members served admission data and clinical documentation to ensure compliance with county and state regulations relating to medical necessity and case documentation
• Understands and applies state, federal and local regulations and laws governing quality assurance and utilization review
• When appropriate, interviews members served, significant others and consults with existing outpatient team
• Consults with psychiatrist and medical staff regarding the members served diagnosis, medical justification, length of treatment, and case documentation
• Assesses records for appropriate level of care and treatment, aftercare, and discharge planning for members served
• Presents any treatment plan disagreements to the treatment team
• Advocates for required members served treatment with medical providers
• Provides training and information about utilization requirements to clinical, supervisory, and management staff
• Participates with departmental staff in utilization and quality improvement meetings and projects
• Maintains effective utilization management communications to customer
• Prepares memorandum, letters, and correspondence and comprehensive daily members served status summaries
• Participates in Quality Assurance (QA) survey audit of the program to ensure agency compliance on utilization review regulations
• If employed at inpatient program, must assist with restraint of members served in the event of assaultive behavior and pass assault crisis/crisis prevention training
• If employed at outpatient program, must evade members served in the event of assaultive behavior and pass assault crisis/crisis prevention training

Benefits

• Paid Time Off: For Full Time Employee it is 16.7 days in your first year
• Nine Paid Holidays & Shift differentials for hourly staff (6% for PM Shift, 10% for Overnight Shift)
• Weekend Shift differentials for hourly staff (5% for Weekend AM Shift, 11% for Weekend PM Shift, 15% for Weekend Overnight Shift)
• Free CEUs, free Supervision for BBS Associate License, coaching, and mentorship
• Online University Tuition Discount and Company Scholarships
• Medical, Vision, Dental Insurance, 401K, Employee Stock Ownership Plan

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree