Utilization Review RN - Mid Shift (3pm - 11:30pm)

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.