Utilization Review RN - Case Management Lead (Mid-Shift)

Kpc Global Medical Centers Inc.; Hemet (CA); On-site; USD 104,000 - 177,000; Full time

Job summary

KPC Global Medical Centers Inc. in Hemet, CA is seeking a Utilization Review RN to review client health records and ensure proper utilization of treatment resources.

The position supports case management and cross-team collaboration to optimize patient care and data reporting. Applicants must hold a CA RN license, a Bachelor's or Master's degree in a health-related field, and at least two years of relevant utilization management experience; weekend work is required and the mid-shift schedule is

Qualifications

• Bachelor's or Master's degree in social work, behavioral or mental health, nursing or other related health field required/preferred.
• CA RN License required.
• Minimum of 2 years' experience with the population of the facility and previous experience in 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 processes and guidelines.
• Reviews patient charts to assess admission/continuation criteria and gathers data for records requests and reporting.
• Able to work independently and use sound judgment.
• Familiar with Federal, State, and intermediary guidelines related to inpatient hospital care and continuity of treatment.
• 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 other related health field preferred.

CA RN License Required

Job description

KPC Global Medical Centers Inc. in Hemet, CA is seeking a Utilization Review RN to review client health records and ensure proper utilization of treatment resources.

The position supports case management and cross-team collaboration to optimize patient care and data reporting. Applicants must hold a CA RN license, a Bachelor's or Master's degree in a health-related field, and at least two years of relevant utilization management experience; weekend work is required and the mid-shift schedule is