Utilization Review RN: Case Mgmt & Discharge (Evenings)

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

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.