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Posted: 03-Jan-23
Location: Fountain Valley, California
Salary: Open
Categories:
Internal Number: 2205024247
Fountain Valley Regional Hospital is proud of the full range of quality services we provide. Since 1971, we have dedicated our efforts to meet and serve the medical needs of our growing community. We were the first hospital in Orange County to offer residents an accredited Chest Pain Center and a Thrombectomy Receiving Center certified by The Joint Commission. We are one of only two certified Pediatric ICUs in Orange County and the only hospital in Fountain Valley and Huntington Beach with a Level III Neonatal ICU. We�re proud of the efforts of our physicians, nurses and staff who strive to provide you with the best care possible.
We offer competitive salaries and benefits including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions.
RN Utilization Review Part Time Days Position Summary:
The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient�s resources and right to self-determination.
The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions.
This position integrates national standards for case management scope of services including:
Utilization Management supporting medical necessity and denial prevention
Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
Education provided to physicians, patients, families and caregivers
The Case Manager will perform the initial IQ and clinical review, within one working day of admission and document in eCARE
The Case Manager will perform continued stay IQ and document in eCARE a concurrent review every 3 days or sooner if change in LOC or clinical status.
The Case Manager will review all Observation patients daily per P&P #8756-M 8.0
Prepares review sheets for all patients, Medi-cal, (via TAR) Medicare, IMS and cash as well as other financial classes.
Initiates discharge planning per Department standard. All payor sources are screened for high risk, high volume and problem prone patients.
Conducts interview with patients and significant others. Explores avenues of discharge planning.
Demonstrates a knowledge of human behavior and counseling skills as they relate to patient and staff needs.
Documents in eCare information and events as they occur. Maintain verbal and written communication with physician, staff, and family regarding discharge planning process. Notes signed (with name and title) and dated with each entry into the discharge planning record.
Implements innovative discharge planning when needs are out of the ordinary or resources unavailable. Utilizes insurance plan's case management for planning, if available.
Assists patients and families with information regarding social, economic and emotional aspects and makes necessary referral to social work, financial counseling or educational resources. Is a resources person to patients and families. Assists physicians in transferring patients to other facilities. Coordinates exchange of information, records, transportation and notifications. Documents activities in Discharge Planning notes.
Educates medical and nursing staff on discharge planning for continuity of care. Lower level of care; i.e., role of HHC, SNF, REHAB, etc. Interprets Medi-care, Medi-Cal, IMS, private insurance and HMO's as they pertain to discharge planning. Acts as a public relations person. Participates in meeting and inservices by outside providers. Network with others in the community.
Participates in and initiates case conferences. Attends rehabilitation rounds as indicated. Assists in development of policies and procedures and documentation forms.
Completes activities related to Observation, one day stays, concurrent and retroactive TAR documentation.
Returns all telephone reviews to insurance companies within one working day
RN Utilization Review Part Time Days candidate will possess the following education, licenses/certifications, and experience:
Minimum Education: Knowledge necessary to obtain RN license in the state of California and current California RN license required.
Preferred: Bachelor of Science in Nursing (BSN); Accreditied Case Manager (ACM)
Minimum Experience: Three (3) to five (5) years experience in an acute care hospital setting preferred. Acute hospital case management experience preferred.
Required: Two (2) years acute hospital patient care experience.
Preferred Skills and Abilities: Broad knowledge of Medicare, Medi-Cal and insurance guidelines. Good written and verbal communication skills.
The hospital, in its sole discretion, reserves the right to combine any of the above required experiences, or to consider applicants other work related experience in order to meet the above mentioned requirements.
Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
Pay Range: $44.00 - $67.84
Individual wages are determined based upon a number of factors including, but not limited to, an employee�s qualifications and experience.
Employment practices will not be influenced or affected by an applicant�s or employee�s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
