Utilization Review RN

Kpc Global Medical Centers Inc.; Santa Ana (CA); On-site; USD 69,000 - 117,000; Full time

Job summary

KPC Global Medical Centers Inc. is seeking a Utilization Review RN in Santa Ana, CA. The role focuses on reviewing health records to ensure appropriate utilization of treatment resources and supporting case management.

Requirements include CA RN license and a Bachelor's or Master's in a health field. Minimum 2 years of relevant experience is preferred; weekend availability is required.

Qualifications

• CA RN license is required.
• Bachelor's or Master's degree in social work, behavioral or mental health, nursing or related health field preferred.
• Minimum of 2 years' experience with the facility population and utilization management preferred.

Responsibilities

• Coordinates and reviews all medical records, as assigned to caseload.
• Participates in Case Management and Treatment Team meetings.
• Educates departments on utilization review processes.
• Reviews patient charts to assess admission/continuation criteria and gathers related data for reporting.
• Able to work independently and use sound judgment.
• Familiar with Federal, State, and intermediary guidelines for inpatient, acute care and continuity of care.
• Coordinates discharge referrals as requested by clinical staff and families.
• Performs other duties as assigned.

Skills

Communication

Problem Solving

Attention to Detail

Education

Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or related health field preferred

CA RN License Required

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time KPC SANTA ANA, Santa Ana, CA, US

3 days ago Requisition ID: 1544

Salary Range: $50.00 To $85.00 Hourly

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
• 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.

• 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.