Evaluates the clinical status of patients using evidence based criteria to determine medical necessity for admission into acute care setting, need for consulting services, or transfer/discharge. Utilizes information about clinical condition, prior level of functioning and anticipated treatment plan to support a safe, smooth transition to other levels of care.
Education: Graduate of a nursing program, leading to RN licensure.
Experience: A minimum of three years acute hospital experience. Experience in utilization review, discharge planning and/or case management is required.
Knowledge and Skills: Knowledge of common disease processes, knowledge of health care delivery systems, demonstrates understanding of common reimbursement methodologies. Able to manage competing priorities and effectively prioritizes work. Evaluates the clinical status of patients using evidence based criteria to determine medical necessity for hospitalization. Utilizes information about clinical condition, prior level of functioning and anticipated treatment plan to support safe, smooth transition to other levels of care.
License and Certifications: Current RN licensure in the State of California and a current American Heart Association (AHA) BLS card are required.
Equipment: Basic computer skills with working knowledge of Word. Willingness to learn all aspects of the Business Services, Case Management, Emergency Department and hospital wide electronic medical record systems.
Physical Requirements: Must be able to perform the essential physical requirements of the job as noted in the job description.