RN, Utilization Review:NICU Job - (fresno, CA)

RN, Utilization Review:NICU Type Regular Full:Time (30+ hours) Posted Date 9/5/2013 Summary: Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients' health care needs without compromising quality outcomes. Responsibilities: 1. Performs on:site and/or telephonic review of acute and sub acute services. 2. Predicts and plans for patient's needs from pre:admission, through acute and sub acute care and post:discharge, in collaboration with the member. 4. Acts in conjunction with the appropriate manager(s) on a daily basis to assess the inpatient census for appropriate alternative health care service needs. 5. Coordinates with appropriate discharge planning team members, facility utilization management department, physicians and members to coordinate timely discharges. 7. Acts in conjunction with the clinical team related to discharge planning (e.g., home care, hospice care, rehabilitation care, special program care, transitional care, occupational therapy, speech, respiratory and physical therapy), durable equipment and disposable supplies. 8. Documents all activities in the appropriate system(s) on a timely basis. 9. Participates in rounds with the Medical Director. 11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria. Qualifications: EDUCATION AND EXPERIENCE Education Required: : Nursing Diploma. : Associate's Degree in related Health/Nursing field. Preferred: : Bachelor's Degree in related Health/Nursing field. Years and Type of Experience Required: Required: : Minimum of two years of utilization management or hospital/acute care experience. Preferred: : Minimum of three years experience in health care, case management, discharge planning, utilization management, or behavioral health. : Experience working on the community level and with community agencies. Certifications or Licensures Required: : RN Preferred: : Certified Professional Healthcare Management Language Skills Required: : English Preferred: : Bilingual Functional Competencies : Experience working with utilization management data systems. PHYSICAL REQUIREMENTS The ph Source:

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