Utilization Review RN

KPC Global MSO

Santa Ana, CA

SUMMARY

The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources.

RESPONSIBILITIES AND DUTIES:

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.

This position is a mid-shift (3pm - 11:30pm) and will need to work on weekends.

EDUCATION & EXPERIENCE 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.

SKILLS & ABILITIES REQUIREMENTS:

Communication
Planning & Organizing
Problem Solving
Attention to Detail

PHYSICAL REQUIREMENTS:

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.

Working Environment:

Work in an office, where the climate is controlled.
OSHA exposure category: I

Category I - Position includes tasks that involve exposure to Blood borne Pathogens.
Category II - Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks.
Category III - Positions includes tasks that do not involve exposure to Bloodborne Pathogens. This position would not be required to perform Category I tasks.

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Vacancy posted 8 hours ago

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