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Utilization Review Nurse

KPC Global MSO
Corona, CA Full Time
POSTED ON 12/31/2022 CLOSED ON 3/1/2023

What are the responsibilities and job description for the Utilization Review Nurse position at KPC Global MSO?

SUMMARY
The Utilization Review Nurse 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 or LVN 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.

Salary : $59,700 - $75,600

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