Utilization Review Nurse & Discharge Planner

Kern Medical; Bakersfield (CA); On-site; USD 90,000 - 142,000; Full time

Job summary

Kern Medical in Bakersfield, CA is hiring a Utilization Review Nurse to support hospital admissions review and discharge planning. You will evaluate medical records, coordinate with payors, and discuss care changes with attending physicians.

The role emphasizes DRG initiation, reimbursement documentation, and collaboration across departments. Requires California RN license and 2 years acute care experience; BLS within 60 days.

Qualifications

• RN license in California required.
• Two years of RN experience in an acute care hospital.
• Experience in case management and utilization/discharge planning preferred.
• BLS certification required or to be obtained within 60 days.

Responsibilities

• Obtain and evaluate medical records for inpatient admissions.
• Initiate physician advisories as needed for unwarranted admissions.
• Conduct ongoing reviews and discuss care changes with physicians.
• Formulate and document discharge plans.
• Coordinate with hospital services to optimize resources.
• Review payor documentation requirements and reimbursement processes.
• Initiate and complete DRGs for Medicare payment.
• Answer provider questions regarding reimbursement and prior authorization.
• Educate providers on documentation to maximize reimbursement.
• May assist in training other Utilization Review Nurses.
• Maintain knowledge of patient disease processes and treatment modalities.

Skills

Utilization Review

Discharge planning

Medical records

Nursing knowledge

Job description

Kern Medical in Bakersfield, CA is hiring a Utilization Review Nurse to support hospital admissions review and discharge planning. You will evaluate medical records, coordinate with payors, and discuss care changes with attending physicians.

The role emphasizes DRG initiation, reimbursement documentation, and collaboration across departments. Requires California RN license and 2 years acute care experience; BLS within 60 days.