What are the responsibilities and job description for the Travel RN Case Manager – Utilization Review - $3,282 per week position at Coast Medical Service?
- Certification Details
- BLS (Basic Life Support)
- Valid Registered Nurse license in the State of California.
- Job Details
- Utilization Review Nurse II represents the fully experienced level in utilization review and discharge planning activities.
- 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 on-going reviews and discusses care changes with attending physicians and others.
- Formulates and documents discharge plans.
- Provides on-going consultation and coordination with multiple services within the hospital to ensure efficient use of hospital resources.
- Identifies pay source problems and provides intervention for appropriate referrals.
- Coordinates with admitting office to avoid inappropriate admissions.
- Coordinates with clinic areas in scheduling specialized tests with other health care providers, assessing pay source and authorizing payment under Medically Indigent Adult program as necessary.
- Reviews and approves surgery schedule to ensure elective procedures are authorized.
- Coordinates with correctional facilities to determine appropriate use of elective procedures, durable medical goods and other services.
- Answers questions from providers regarding reimbursement, prior authorization and other documentation requirements.
- Learns the documentation requirements of payor sources to maximize reimbursement to the hospital.
- Keeps informed of patient disease processes and treatment modalities.
- Teaches providers the documentation requirements of payor sources to maximize reimbursement to the hospital.
- May assist in training Utilization Review Nurse I workers.
- Performs other job-related duties as assigned.
- Job Requirements
- Two (2) years of experience or its equivalent as a registered nurse in an acute care hospital.
- At least one (1) year of experience must be on a medical/surgical ward or unit.
- One (1) year of utilization review/discharge planning experience in an acute care hospital OR Two (2) years of experience as a Case Manager in an alternate medical setting such as a clinic or physician’s office performing utilization review or discharge planning.
- Knowledge of payor source documentation requirements and governmental regulations affecting reimbursement.
- Knowledge of acute care nursing principles, methods and commonly used procedures.
- Knowledge of common patient disease processes and the usual methods for treating them.
- Knowledge of medical terminology, hospital routine and commonly used equipment.
- Knowledge of acute hospital organization and the interrelationships of various clinical and diagnostic services.
- Ability to effectively evaluate the medical records of hospital admissions regarding continuing stay necessity, appropriateness of setting, delivered care, use of ancillary services and discharge plans.
- Ability to assess and judge the clinical performance of physicians and other health professionals.
- Ability to communicate documentation needs in an effective and tactful manner that promotes cooperation.
- Ability to teach co-workers what is needed and required in the medical record for reimbursement and audit purposes.
- Ability to gather and analyze data and prepare reports and recommendations based thereon.
- Ability to get along with physicians, other health providers, outside payor sources and the general public.
- California RN license required.
- Utilization review and InterQual Guidelines experience required.
- Schedule Information
- Night shift.
- 8 hours per day.
- 40 hours per week.
- Monday-Friday 8-4:30 with rotating weekend coverage position.
- Additional Details
- California experience required.
- Must have utilization review and InterQual Guidelines experience.
Salary : $3,282