Utilization Review RN
KPC GLOBAL MEDICAL CENTERS INC.•Santa Ana, CA
5h
About The Position
The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources.
Requirements
- Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
- CA RN License Required
- Minimum of 2 years' experience with the population of the facility and previous experience in utilization management preferred.
- Communication
- Planning & Organizing
- Problem Solving
- Attention to Detail
- BODY POSITIONS: SITTING AND STANDING FOR PROLONGED PERIODS.
- BODY MOVEMENTS: ARM AND HAND DEXTERITY.
- BODY SENSES: MUST HAVE COMMAND OF CLOSE AND DISTANT SIGHT, COLOR PERCEPTION AND HEARING.
- STRENGTH: ABILITY TO LIFT AND MOVE UP TO 25-POUNDS.
Responsibilities
- Coordinates and reviews all medical records, as assigned to caseload.
- Actively participates in Case Management and Treatment Team meetings
- Serves as on-going educator to all departments.
- Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from fiscal intermediary; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting
- Able to work independently and use sound judgment.
- Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.
- Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.
- Performs other duties as assigned.
