What are the responsibilities and job description for the Utilization Review RN - Victor Valley Global Medical Center position at KPC GLOBAL MEDICAL CENTERS INC.?
Job Description
Job Description
SUMMARY
The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources.
REQUIREMENTS
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.
EDUCATION & EXPERIENCE REQUIREMENTS :
SKILLS & ABILITIES REQUIREMENTS :
PHYSICAL REQUIREMENTS :
Working Environment :
