Utilization Review Nurse - (RN) - Per Diem
Company: Kern County Hospital Authority
Location: Arvin
Posted on: March 19, 2023
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Job Description:
Job Description:
Kern Medical has been a community cornerstone since its founding in
1867. Today, we are an acute care teaching center with 222 beds,
offering the only advanced trauma care between Fresno and Los
Angeles. Kern Medical offers a range of primary, specialty, and
multi-specialty services, including high-risk pregnancy care,
inpatient psychiatric services integrated with county mental health
programs, and a growing network of outpatient clinics providing
personalized patient-centered wellness care. Kern Medical cares for
15,500 inpatients and 125,000 clinic patients a year.Per Diem,
employees supplement department staffing needs with no guarantee of
minimum hours.Per Diem minimum scheduling expectation is one (1)
shift per four-week schedule. Position: Utilization Review Nurse -
(RN) - Per Diem Job Description Under supervision, to provide and
implement a hospital utilization review and discharge planning
program and to do related work as required. DISTINGUISHING
CHARACTERISTICS: Positions in this classification are assigned to
the Utilization Review division of Kern Medical. Incumbents perform
clinically oriented medical chart reviews and other administrative
tasks to meet the requirements of the medical center's utilization
review plan, state and federal regulations, insurance company
requirements for reimbursement, and facility accreditation
standards. Utilization Review Nurse I represents the entrance level
for administrative tasks concerning Utilization Review and
Discharge planning activities. Incumbents are expected to apply
knowledge gained in clinical practice to patient care situations
that may be affected by regulatory constraints. The Utilization
Review Nurse I level is expected to gain a full working knowledge
of applicable regulations and to develop knowledge of outside
agencies and services to develop appropriate discharge plans.
Utilization Review Nurse II represents the fully experienced level
in utilization review and discharge planning activities. Essential
Functions:Obtains and evaluates medical records for in-patient
admissions to determine if required documentation is
present.Obtains appropriate records as required by payor agencies
and initiates Physician Advisories as necessary for unwarranted
admissions.Conducts ongoing reviews and discusses care changes with
attending physicians and others.Formulates and documents discharge
plans.Provides ongoing consultation and coordination with multiple
services within the hospital to ensure efficient use of hospital
resourcesIdentifies pay source problems and provides intervention
for appropriate referralsCoordinates with admitting office to avoid
inappropriate admissions.Coordinates with clinic areas in
scheduling specialized tests with other health care providers,
assessing pay sources, and authorizing payment under the Medically
Indigent Adult program as necessary.Reviews and approves surgery
schedules to ensure elective procedures are authorized.Coordinates
with correctional facilities to determine the appropriate use of
elective procedures, durable medical goods, and other
services.Answer questions from providers regarding reimbursement,
prior authorization, and other documentation requirements.Learns
the documentation requirements of payor sources to maximize
reimbursement to the hospitalKeeps informed of patient disease
processes and treatment modalities.Level II Teaches providers the
documentation requirements of payor sources to maximize
reimbursement to the hospital.Level II May assist in training
Utilization Review Nurse I's.Performs other job-related duties as
assigned. Employment Standards: Possession of a valid license as a
Registered Nurse in the State of California AND (Level I) two (2)
years of experience or its equivalent as a registered nurse in an
acute care hospital, at least one (1) of which was on a
medical/surgical ward or unit. (Level II) one (1) year of
utilization review/discharge planning experience in an acute care
hospital or as a Case Manager in an alternate medical setting such
as a clinic or physician's office performing utilization review or
discharge planning. OR Possession of a valid license as a
Registered Nurse in the State of California And two (2) years of
experience as a Case Manager in an alternate medical setting such
as a clinic or physician's office performing utilization or
discharge planning. Incumbents may be required to possess and
maintain specific certificates of competency based on unit-specific
requirements as a condition of employment. Possession and
maintenance of a current American Heart Association Healthcare
Provider Basic Life Support (BLS) card. Appointees not possessing
the BLS card must successfully complete appropriate training and
qualify for the BLS card within 60 days of employment. Employees
must maintain all health requirements designated by Kern Medical
Center. Possess and maintain a current American Heart Association
Healthcare Provider Basic Life Support (BLS) card. A background
check will be conducted for this classification.Licenses &
CertificationsRequiredRegistered Nurse
Keywords: Kern County Hospital Authority, Bakersfield , Utilization Review Nurse - (RN) - Per Diem, Healthcare , Arvin, California
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