Registered Nurse II​/III​/IV - QI Inpatient Program

Position

Riverside University Health System (RUHS) – Behavioral Health is recruiting a Registered Nurse II/III/IV to support its Quality Improvement (QI) Inpatient Program in Riverside.

9‑80 schedule. Some weekend work may be required.

• Review the clinical records of patients admitted to psychiatric inpatient facilities to determine if the documentation adequately supports medical necessity.
• Demonstrate an in‑depth knowledge of the symptoms, behaviors, factors and documentation that meet the standards of medical necessity as defined by Title 9, Medi‑Cal, the California Department of Health Care Services (DHCS) and other relevant regulatory agencies.
• Recognize and gather all information needed to make an independent determination, to synthesize, reference applicable medical necessity standards and ultimately determine whether medical necessity is present.
• Accurately and concisely document the clinical information that does or does not support medical necessity and the reasoning that produced the final determination.
• Identify situations where a definitive determination cannot be made and seek consultation with a QI Inpatient psychiatrist.
• Discuss medical necessity standards with nurses, psychiatrists, social workers, care managers, placement workers and other mental health personnel via email, phone or face‑to‑face.
• Attend treatment rounds at some inpatient facilities and provide immediate education and feedback to hospital staff.
• Provide formal training to inpatient staff or other parties and assist in training new QI Inpatient RN staff.
• Evaluate for potential quality‑of‑care (QOC) issues during medical necessity reviews; when identified, consult with a QI Inpatient psychiatrist on possible actions.
• Participate in periodic audits of psychiatric inpatient facilities, including ITF, PHF and fee‑for‑service hospitals; lead audits when designated. Prepare documents, data and presentations for the triennial DHCS audit.
• Serve on committees as directed by the supervisor, including the Plan of Correction (POC) Committee, to assure relevant standards are met in anticipation of the DHCS audit.
• Provide no direct patient care as a QI Inpatient nurse. Prior experience in a psychiatric inpatient facility is required; experience in quality improvement, utilization management or case management is a plus.
• Report to the Manager of QI Inpatient and perform other reasonable duties not enumerated above.

• Registered Nurse with a current valid license to practice in California.
• Minimum one year of RN experience in acute care, mental health, outpatient settings or a healthcare agency program (interim permit counts). Experience for RN II, III, IV may require additional years as outlined below.
• Prior Registered Nurse experience working in psychiatric/behavioral health settings is essential.
• Experience with utilization review and inpatient clinical practice.
• Strong proficiency navigating multiple electronic medical records (EMRs) simultaneously.
• Working knowledge of Microsoft Office (Word, Excel, Outlook).
• Typing speed of at least 40 words per minute.
• Excellent communication and organizational skills.
• Basic Life Support (BLS) certificate issued by the American Heart Association.
• Valid California driver’s license may be required.
• Knowledge of child, dependent adult, elder abuse reporting laws, involuntary detention and commitment laws, involuntary psychotropic medication laws and Tarasoff‑duty to warn requirements.

Registered Nurse II – $42.87–$59.92 per hour.

Registered Nurse III – $46.05–$68.49 per hour.

Registered Nurse IV – $49.27–$72.26 per hour.

• Maintain a current valid RN license in California.
• Maintain a current BLS certificate.
• Maintain a current California driver’s license if required.

For questions regarding this recruitment contact the recruiter Nicole Prado: nprado.

For more information visit:(Use the "Apply for this Job" box below)..