Rn Jobs in Bay Area

About The Position

Requirements

• Bachelor of Science in Nursing (BSN) from an accredited school of nursing.
• Three (3) years of utilization review experience.
• A minimum of three (3) years in an acute care setting.
• Previous experience with hospital information systems (order entry, results reporting, case management).
• Basic experience using PC/computer (word processing minimum).
• FL Registered Nurse License

Nice To Haves

• Active Case Management Certification (CCM or ACM) or within one (1) year of hire and membership in relevant CM/UM organization.
• Demonstrated ability to manage multiple tasks and adjust priorities according to patient and department/hospital needs.
• Solid clinical assessment, critical thinking, decision making and organizational skills.
• Strong ability to communicate effectively both verbally and in written work.
• Strong interpersonal skills and ability to work collaboratively with leaders, staff, patients, families, healthcare team, payers and external agencies.
• Knowledge of relevant federal and state utilization review and appeal requirements.

Responsibilities

• Utilizes professional nursing and critical thinking skills to assess patients for a clinically appropriate level of care.
• Maintains a strong knowledge base of evidence-based clinical criteria, federal and state UR requirements.
• Identifies pertinent clinical information that will support admission and continued stay hospitalization.
• Collaborates with floor ICM staff, Revenue Cycle, involved physicians and/or the Physician Advisors (PA) to overturn denials or determine appropriate patient transition.
• Interacts extensively with clinical staff, other ICM staff, physicians, payers, and hospital financial staff to achieve appropriate level of care or placement authorizations and avoid denials.
• Collaborates with other ICM staff to evaluate opportunities to optimize utilization and secure payer approvals across populations of patients.
• Acts as a mentor/preceptor for new staff.