Utilization Review RN

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 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 1. Category I – Position includes tasks that involve exposure to Blood borne Pathogens. 2. Category II – Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks. 3. Category III – Positions includes tasks that do not involve exposure to Bloodborne Pathogens.  This position would not be required to perform Category I tasks.