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Utilization Review RN
Career Insights for Registered Nurse (General)
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Based on California data
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What they do
A Registered Nurse provides medical care and treatment, educates patients about their conditions, and provides emotional support to patients and families. Works in hospitals, schools, clinics or community health centers. Works under the supervision of a physician or other specialist, and serves as the primary point of care for patients in a hospital setting. May specialize in emergency room work, or treatment for a particular condition, or specialize in working with infants, the elderly or other patient groups. May work as an advanced practice specialists and prescribe medications in addition to offering specialty care.
$100,785 / year median in California
+10% projected growth
Job Description
RN KPC GLOBAL MEDICAL CENTERS INC.
- 2.6 Santa Ana, CA Job Details Full-time $50
- $85 an hour 1 day ago Qualifications RN License Decision making Full Job Description 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 DetailPHYSICAL 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.