Utilization Review RN (Hemet)

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

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 HEMET, Hemet, CA, US

3 days ago Requisition ID: 1546

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.