Utilization Review RN

3 weeks ago

San Leandro, United States Telecare Corp. Full time

0Telecare's mission is to deliver excellent and effective behavioral health services that engage individuals with complex needs in recovering their health, hopes, and dreams. Telecare continues to advance cultural diversity, humility, equity, and inclusion at all levels of our organization by hiring mental health peers, BIPOC, LGBTQIA+, veterans, and all belief systems.

As part of the Telecare family, Villa Fairmont is licensed as a 99-bed Mental Health Rehabilitation Center. It serves adults who have a history of serious and persistent mental illness with repeated hospitalizations.

Full Time; DAYS Shift; Monday - Friday

Expected starting wage range is $51.85 - $70.17. Telecare applies geographic differentials to its pay ranges. The pay range assigned to this role will be based on the geographic location from which the role is performed. Starting pay is commensurate with relevant experience above the minimum requirements.

POSITION SUMMARY

The Utilization Review (UR) Nurse works collaboratively with the county or customer utilization and the treatment team to ensure that the care provided is appropriate and medically necessary. The UR Nurse also ensures that medical record documentation explains the care provided as well as the members served response to treatment. The UR Nurse will support programs as assigned and attend treatment team meetings.

QUALIFICATIONS

Required:

* Graduation from an accredited Registered Nursing Program (RN). Two (2) years of inpatient psychiatric nursing experience. Current RN State license. Current BLS certification.
* Must be at least 18 years of age
* Must be CPR, First Aid, and CPI certified (hands-on course) on date of employment or prior to providing direct client care and maintain current certification throughout employment
* All opportunities at Telecare are contingent upon successful completion and receipt of acceptable results of the applicable post-offer physical examination, 2-step PPD test for tuberculosis, acceptable criminal background clearances, excluded party sanctions, and degree or license verification. Position requires driving, valid driver's license, a motor vehicle clearance and proof of auto insurance is required at time of employment and must be maintained throughout employment. Additional regulatory, contractual or local requirements may apply

Preferred:

* Utilization Review Nurse experience preferred

ESSENTIAL FUNCTIONS

* Demonstrates the Telecare mission, purpose, values, and beliefs in everyday language and contact with the internal and external stakeholders
* Reviews members served admission data and clinical documentation to ensure compliance with county and state regulations relating to medical necessity and case documentation
* Understands and applies state, federal and local regulations and laws governing quality assurance and utilization review
* When appropriate, interviews members served, significant others and consults with existing outpatient team
* Consults with psychiatrist and medical staff regarding the members served diagnosis, medical justification, length of treatment, and case documentation
* Assesses records for appropriate level of care and treatment, aftercare, and discharge planning for members served
* Presents any treatment plan disagreements to the treatment team
* Advocates for required members served treatment with medical providers
* Provides training and information about utilization requirements to clinical, supervisory, and management staff.
* Participates with departmental staff in utilization and quality improvement meetings and projects
* Maintains effective utilization management communications to customer
* Prepares memorandum, letters, and correspondence and comprehensive daily members served status summaries
* Participates in Quality Assurance (QA) survey audit of the program to ensure agency compliance on utilization review regulations
* Must assist with restraint of members served in the event of assaultive behavior and pass assault crisis/crisis prevention training

Duties and responsibilities may be added, deleted and/or changed at the discretion of management.

Position requires driving own personal vehicle for company business such as trainings, offsite meetings, etc.

SKILLS

Thorough knowledge of:

* Psychological and social aspects and characteristics of emotional disturbances and mental illness
* Principles and methods of counseling and the accepted techniques for assessing psycho-social behavior

Working knowledge of:

* Human behavior and development
* Appropriate and available community resources
* Problems, needs and attitudes of the population served
* Pertinent laws and regulations regarding health and social service programs
* Federal, state and county regulations pertaining to utilization review and members served
* Pharmacology of medications and psychotropic drug treatment
* Methods and procedures of admissions, discharges, and members served in psychiatric facilities

Ability to:

* Advanced ability to review records and proficient in use of electronic health records, I.E. Avatar, PCC, etc., and Microsoft Suite products
* Communicate effectively in oral and written format
* Maintain effective interpersonal relationships
* Work independently
* Analyze treatment plans, which include the diagnosis of members served behavioral and emotional problems
* Use good judgement in order to make critical decisions about the medical necessity of treatment
* Work in a high stress environment

PHYSICAL DEMANDS

The physical demands here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

The employee is occasionally required to sit, squat, kneel, twist, push, pull and lift and carry items weighing 25 pounds or less as well as to frequently walk, stand, bend, reach and do simple and power grasping. The position requires manual deviation, repetition and dexterity as well as Hazardous Exposure (Blood Borne Pathogens, Hospital Waste, Chemical & Infectious).

EOE AA M/F/V/Disability

If job posting references any sign-on bonus internal applicants and applicants employed with Telecare in the previous 12 months would not be eligible.

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