Per Diem Registered Nurse II​/III - Utilization Management VCMC

Job Summary

Under direction, scheduled as neededto assist with patient care coordination and utilization review. The incumbent will be responsible for assisting in the evaluation of patient care data in order to coordinate post-discharge needs of patients.

Per Diem Nurses are scheduled to work on an as-needed basis (intermittent) to supplement staffing needs. The ideal candidate will be compassionate, dedicated to providing the highest standard of care to patients, and able to work collaboratively with the multidisciplinary team and multitask in a fast‑paced environment.

• Plans, develops, assesses and evaluates care provided to patients;
• Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use;
• Recommends alternative levels of care and ensures compliance with federal, state and local requirements;
• Assesses high risk patients in need of post-hospital care planning;
• Develops and coordinates the implementation of a discharge plan to meet patient’s identified needs;
• Communicates the plan to physicians, patients, family/caregivers, staff and appropriate community agencies;
• Reviews, monitors, evaluates and coordinates the patient’s hospital stay to assure that all appropriate and essential services are delivered timely and efficiently;
• Participates in the Bed Huddles and carries out recommendations congruent with the patient’s needs;
• Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families;
• Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient and non‑KFH facilities;
• Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred;
• Refers patients to community resources to meet post hospital needs;
• Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation;
• Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to:
  The Joint Commission (TJC), California Department of Health Services (DHCS), Centers for Medicare & Medicaid Services (CMS), and Department of Managed Health Care (DMHC);
• Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources;
• Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness;
• Reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities;
• Reviews, analyzes and identifies utilization patterns, trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities;
• Coordinates, participates and/or facilitates care planning rounds and patient family conferences as needed;
• Participates in committees, teams or other work projects/duties as assigned;
• Performs other duties as required.

• Per Diem RN II:
  Six (6) months of recent acute care nursing experience in an acute hospital setting
• Per Diem RN III:
  Five (5) years of recent acute care nursing experience in an acute hospital setting

• Graduation from an accredited School of Nursing
• Must possess and maintain a current valid license as a Registered Nurse issued by the State of California, or licensure in another state with California licensure pending
• Must have a current, valid Basic Life Support…