Utilization Review Nurse: Case Mgmt & Discharge

Kern Medical; Bakersfield (CA); On-site; USD 90,504 - 142,606; Full time

Job summary

Kern Medical in Bakersfield, CA is seeking a Utilization Review Nurse to join the center that has served the community since 1867. This role focuses on medical chart reviews, discharge planning, and coordination with payor sources to ensure compliant reimbursement.

The position requires an RN licensed in California with at least two years in an acute care setting, and may include additional duties to support utilization review and regulatory adherence.

Qualifications

• Must hold California RN license.
• Two years of experience as an RN in an acute care hospital.
• Experience as Case Manager in clinic or physician’s office performing utilization or discharge planning is acceptable.

Responsibilities

• Obtains and evaluates medical records for inpatient admissions to determine if documentation is complete.
• Coordinates with payor agencies and initiates Physician Advisories as needed for unwarranted admissions.
• Discusses care changes with attending physicians and others.
• Forms and documents discharge plans.
• Provides ongoing consultation and coordination with hospital services to optimize resource use.
• Reviews and approves surgery schedules to ensure proper authorization.
• Initiates and completes DRGs for Medicare payment and educates providers on payor requirements.

Skills

Medical chart reviews

Discharge planning

Regulatory knowledge

Education

Registered Nurse (RN) license (CA)

Job description

Kern Medical in Bakersfield, CA is seeking a Utilization Review Nurse to join the center that has served the community since 1867. This role focuses on medical chart reviews, discharge planning, and coordination with payor sources to ensure compliant reimbursement.

The position requires an RN licensed in California with at least two years in an acute care setting, and may include additional duties to support utilization review and regulatory adherence.