Senior Utilization Review Nurse - Discharge & Reimbursement

Stand Together Ventures Lab; Bakersfield (CA); Sur place; USD 85 000 - 110 000; Plein temps

Résumé du poste

Stand Together Ventures Lab is seeking a Utilization Review Nurse in Bakersfield, CA to implement hospital utilization review and discharge planning programs.

The role involves obtaining and evaluating medical records, coordinating with hospital services and external agencies, and ensuring reimbursement compliance with regulations. Strong communication with providers and data analysis for reporting are essential.

Qualifications

• Valid California RN license with two years of acute care or utilization/discharge planning experience.
• Knowledge of payor documentation, healthcare regulations, patient care processes, and hospital operations.
• Ability to evaluate medical records, communicate effectively with providers, and analyze data for reporting.

Responsabilités

• Obtain and evaluate medical records to assess inpatient admissions.
• Conduct ongoing care reviews and develop discharge plans.
• Coordinate with hospital services and external agencies; ensure reimbursement and regulatory compliance.
• Review and approve surgical schedules; manage pay source issues; educate providers on documentation requirements to maximize reimbursement.

Connaissances

Clinical assessment

Regulatory knowledge

Communication

Collaboration

BLS certification

Formation

California RN license

Description du poste

Stand Together Ventures Lab is seeking a Utilization Review Nurse in Bakersfield, CA to implement hospital utilization review and discharge planning programs.

The role involves obtaining and evaluating medical records, coordinating with hospital services and external agencies, and ensuring reimbursement compliance with regulations. Strong communication with providers and data analysis for reporting are essential.