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Utilization Review RN
2 months ago
SUMMARY
The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources.
REQUIREMENTS
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.
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
- Two or more 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
- 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.
