Unknown Company

Utilization Review RN (Hemet)

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hemet, ca • Posted 1 weeks ago
Onsite Full Time Healthcare Practitioners and Technical Occupations
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
  • Planning & Organizing
  • 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.
Working Environment:
  • Work in an office, where the climate is controlled.
  • OSHA exposure category: I
  1. Category I - Position includes tasks that involve exposure to Blood borne Pathogens.
  2. Category II - Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks.
  3. Category III - Positions includes tasks that do not involve exposure to Bloodborne Pathogens. This position would not be required to perform Category I tasks.

Utilization Review RN (Hemet) in hemet at Unknown Company

Typical pay
$71,760–$112,100

For context, most registered nurses earn between $71,760–$112,100 a year according to Bureau of Labor Statistics wage data. What this particular role pays is set by the employer — check the description above.

This position is listed as full time and onsite.

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