Travel Nurse RN - Case Manager, Utilization Review
Bakersfield, CA
Integrated Healthcare Services
5x8 hrs

Job Title: RN-Case Management (Utilization Review)

Location: Not specified

Employment Type: Not specified

Job Summary: Utilization Review Nurse II represents the fully experienced level in utilization review and discharge planning activities. The role involves obtaining and evaluating medical records for inpatient admissions, conducting ongoing reviews, formulating discharge plans, coordinating hospital resources, and ensuring compliance with payor source documentation requirements. The nurse will also provide consultation, train co-workers, and perform other job-related duties as assigned.

Required Qualifications:

• Two (2) years of experience as a registered nurse in an acute care hospital, with at least one (1) year 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 usual treatment methods.
• Knowledge of medical terminology, hospital routine, and commonly used equipment.
• Knowledge of acute hospital organization and interrelationships of various clinical and diagnostic services.
• Ability to evaluate medical records 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 effectively and tactfully to promote cooperation.
• Ability to teach co-workers about medical record requirements for reimbursement and audit purposes.
• Ability to gather and analyze data and prepare reports and recommendations.
• Ability to work effectively with physicians, other health providers, outside payor sources, and the general public.

Preferred Qualifications:

• Not applicable

Required Certifications & Licensure:

• Valid license as a Registered Nurse in the State of California.
• Current American Heart Association Healthcare Provider Basic Life Support (BLS) card.

Preferred Certifications & Licensure:

• Not applicable