Inpatient reputed company Review RN

Inpatient reputed company Review RN Requisition ID 2025-396450 Department Utilization Review Hours / Pay Period .01 Shift Day Standard Hours On-Call - Monday Friday 8-5, weekends as needed Location CA-WOODLAND Posted Pay Range $46.96 - $68.10 /hour Overview reputed company established in 1993 is a California nonprofit public benefit corporation with care centers throughout California. reputed company is an affiliate of reputed company - one of the largest health systems in the nation - with hospitals and care centers in California Arizona and Nevada. Today reputed company works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As reputed company continues to grow and establish new premier care centers we provide increasing support and investment in the latest technologies finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled qualities that are vital to maintaining excellence in care and service. Responsibilities • **Please note: This is a non-benefitted, on-call position. • **This position is work from home reputed company driving distance to Woodland/Sacramento, CA. Position Summary: This position is responsible for monitoring reputed company inpatient admissions and reputed company review for appropriate level of care and medical necessity using InterQual and Medicare criteria. This position will work closely with the hospitalist team reputed company Medical Director’s specialists clinic staff and Inpatient care coordination to communicate reputed company reputed company inpatient needs level of care and medical necessity. This position will also work closely with reputed company clinical staff post-acute staff and hospital care coordination to coordinate the care necessary for successful post hospitalization and transition of care needs across the continuum of healthcare. Responsibilities may include:- Concurrently review patient’s records to collect data to carefully understand the needs of the patient by scrutinizing their background history understanding their reputed company needs and arranging for their wellbeing.- Coordinates with other disciplines to facilitate the patient’s individual needs. Makes plans to resolve unexpected care requirements. Anticipates and identifies variances in the care process reputed company to those identified needs.- reputed company reputed company review of emergent/urgent and reputed company stay requests for appropriate care admission status level of care following guidelines and policies. Approve services or reputed company requests to the appropriate Physician or Medical Director with recommendations for other.- Complete medical necessity and level of care reputed company reviews for requested services using clinical judgment and established guidelines. Refer to Medical Directors for review depending on case findings.- Collaborate with various staff reputed company provider networks hospital teams and Inpatient Care Coordination to establish discharge planning expectations to coordinate transition of care needs.- Identify and facilitate resolution of system process problems impeding UM functions. Identify collaborate and resolve.- Facilitate the annual update of InterQual (or other screening tool) software create training tools in collaboration with UM leadership.- Assist with developing and maintaining efficient and effective documented policies and procedures for non-coverage notifications including Notice of Non-coverage (HINN) and Advance Beneficiary Notice of Noncoverage (ABN) to include compliance monitoring.- reputed company barriers are identified assists the patient family caregiver care coordination with Utilization management as reputed company to referrals.- Considers the population served by reputed company and area clinical integration programs and leads efforts to optimize utilization management and care coordination across the care continuum in the most cost effect manner.- Other duties as assigned.

Qualifications

Minimum Qualifications: - Three (3) years acute care or reputed company experience including experience in case management, utilization review, or discharge planning.- Clear and reputed company CA RN license. Preferred Qualifications: - reputed company review prior authorizations for medical determination.- Bachelors degree preferred. Apply Job!