Travel Nurse RN - Utilization Review

Job Overview

Integrated Healthcare Services is seeking a travel nurse RN Utilization Review for a travel nursing job in Bakersfield, California.

Utilization Review

RN

13 weeks, 40 hours per week, 8-hour days

Travel

• Obtain and evaluate medical records for in-patient admissions to determine if required documentation is present.
• Obtain appropriate records as required by payor agencies and initiate Physician Advisories as necessary for unwarranted admissions.
• Conduct on-going reviews and discuss care changes with attending physicians and others.
• Formulate and document discharge plans.
• Provide on-going consultation and coordination with multiple services within the hospital to ensure efficient use of hospital resources.
• Identify pay source problems and provide intervention for appropriate referrals.
• Coordinate with admitting office to avoid inappropriate admissions.
• Coordinate with clinic areas in scheduling specialized tests with other health care providers, assessing pay source and authorizing payment under Medically Indigent Adult program as necessary.
• Review and approve surgery schedule to ensure elective procedures are authorized.
• Coordinate with correctional facilities to determine appropriate use of elective procedures, durable medical goods and other services.
• Answer questions from providers regarding reimbursement, prior authorization and other documentation requirements.
• Learn the documentation requirements of payor sources to maximize reimbursement to the hospital.
• Keep informed of patient disease processes and treatment modalities.
• Teach providers the documentation requirements of payor sources to maximize reimbursement to the hospital.
• Assist in training Utilization Review Nurse I's.
• Perform other job related duties as assigned.

• Possession of a valid license as a Registered Nurse in the State of California.
• (Level I) Two (2) years of experience or its equivalent as a registered nurse in an acute care hospital, at least one (1) year on a medical/surgical ward or unit.
• (Level II) One (1) year of utilization review/discharge planning experience in an acute care hospital or as a Case Manager in an alternate medical setting such as a clinic or physician’s office performing utilization review or discharge planning.
• OR possession of a valid license as a Registered Nurse in the State of California and two (5) years of experience as a Case Manager in an alternate medical setting performing utilization or discharge planning.
• Ability to effectively evaluate the medical records of hospital admissions regarding continuing stay necessity, appropriateness of setting, delivered care, use of ancillary services and discharge plans.
• Ability to assess and judge the clinical performance of physicians and other health professionals.
• Ability to communicate documentation needs effectively and tactfully to promote cooperation.
• Ability to teach co-workers what is needed and required in the medical record for reimbursement and audit purposes.
• Ability to gather and analyze data and prepare reports and recommendations based on that data.
• Ability to get along with physicians, other health providers, outside payor sources and the general public.

• Experience in California, preferably more than 1 assignment.
• Ability to perform both Utilization review and Care Coordination/Discharge planning.
• Experience in acute care/ICU/ED units.
• Extra:
  Trauma facilities experience.
• Experience with teaching facilities.

• Possession and maintenance of a current American Heart Association Healthcare Provider Basic Life Support (BLS) card.
• Incumbents may be required to possess and maintain specific certificates competency based on unit specific requirements as a condition of employment.

• Work Authorization: US Citizen.
• Preferred years of experience: 2 years.
• Travel required:
  
  No travel required.
• Shift timings:
  Days.

Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax‑free stipend amount to be determined.

Integrated Healthcare Services Job  #. Posted job title: RN-Utilization Review.