Utilization Review RN

KPC GLOBAL MEDICAL CENTERS • Santa Ana, CA

2d • Onsite

About The Position

The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources. This position is a mid-shift (3pm - 11:30pm) and will need to work on weekends.

Requirements

• CA RN License Required
• Minimum of 2 years' experience with the population of the facility
• 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.
• Able to work independently and use sound judgment.

Nice To Haves

• previous experience in utilization management preferred.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level