Seeking candidates for a Utilization Review RN career opportunity with our healthcare client in Anaheim, CA.

The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources.

RESPONSIBILITIES:

• Coordinates and reviews all medical records, as assigned to caseload.
• Actively participates in Case Management and Treatment Team meetings
• Serves as on-going educator to all departments.
• Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from fiscal intermediary; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting
• Able to work independently and use sound judgment.
• Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.
• Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.

EDUCATION & EXPERIENCE

• Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
• CA RN License Required
• Two or more years' experience with the population of the facility and previous experience in utilization management preferred.