Continuing Care Utilization Review Coordinator RN
3 weeks ago
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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