Continuing Care Utilization Review Coordinator RN

3 weeks ago


Dubai, Dubai, United Arab Emirates Health eCareers Full time

Job Summary

As a Continuing Care Utilization Review Coordinator RN at Health eCareers, you will play a vital role in conducting utilization reviews for in-house patients and contracted facilities. Your expertise will assist in the discharge planning process, ensuring seamless transitions for our patients.

Key Responsibilities

  • Conduct thorough utilization reviews for in-house patients and contracted facilities, identifying areas for improvement and optimizing care.
  • Collaborate with physicians to ensure adherence to established treatment criteria and Kaiser clinical guidelines.
  • Develop and implement quality improvement initiatives to enhance the quality of services and reduce costs.
  • Assist in collecting and analyzing clinical data to inform decision-making and drive positive outcomes.
  • Generate actionable insights and reports to inform strategic planning and resource allocation.
  • Investigate and resolve complex clinical issues, ensuring compliance with regulatory requirements and organizational policies.
  • Support the discharge planning process, working closely with healthcare providers to ensure a smooth transition of care.
  • Counsel patients and families on Medicare and health plan coverage, providing education and support to promote informed decision-making.
  • Coordinate referrals to appropriate agencies and facilities, ensuring timely and effective care transitions.

Requirements

  • Minimum two years of experience in an inpatient setting or skilled nursing facility.
  • Minimum one year of utilization experience required.
  • Bachelor's degree in nursing or health-related field, or four years of experience in a directly related field.
  • Current Registered Nurse License (California) and Basic Life Support certification.
  • Demonstrated knowledge of diagnostic codes and ability to work in a Labor/Management Partnership environment.

Preferred Qualifications

  • Clinical expertise in area of review preferred.
  • Masters degree preferred.


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