Case Management Nurse | RN| Bakersfield, CA | $80/hr

Case Management Nurse RN | Bakersfield, CA | $80/hrContract Duration: 13 weeks with possible extension Job Summary:Utilization Review Nurse II represents the fully experienced level in utilization review and discharge planning activities. Job Responsibilities:-Obtains and evaluates medical records for in-patient admissions to determine if required documentation is present. -Obtains appropriate records as required by payor agencies and initiates Physician Advisories as necessary for unwarranted admissions. -Conducts on-going reviews and discusses care changes with attending physicians and others. -Formulates and documents discharge plans. -Provides on-going consultation and coordination with multiple services within the hospital to ensure efficient use of hospital resources. -Identifies pay source problems and provides intervention for appropriate referrals. -Coordinates with admitting office to avoid inappropriate admissions. -Coordinates with clinic areas in scheduling specialized tests with other health care providers, assessing pay source and authorizing payment under Medically Indigent Adult program as necessary. -Reviews and approves surgery schedule to ensure elective procedures are authorized. -Coordinates with correctional facilities to determine appropriate use of elective procedures, durable medical goods and other services. -Answers questions from providers regarding reimbursement, prior authorization and other documentation requirements. -Learns the documentation requirements of payor sources to maximize reimbursement to the hospital. -Keeps informed of patient disease processes and treatment modalities. -Teaches providers the documentation requirements of payor sources to maximize reimbursement to the hospital. -May assist in training Utilization Review Nurse I workers. -Performs other job-related duties as assigned.Skills:Required Skills & Experience:-(Level I) Two (2) years of experience or its equivalent as a registered nurse in an acute care hospital. -At least one (1) year of experience must be on a medical/surgical ward or unit. -(Level II) One (1) year of utilization review/discharge planning experience in an acute care hospital.OR -Two (2) years of experience as a Case Manager in an alternate medical setting such as a clinic or physician’s office performing utilization review or discharge planning.-Knowledge of payor source documentation requirements and governmental regulations affecting reimbursement. -Knowledge of acute care nursing principles, methods and commonly used procedures. -Knowledge of common patient disease processes and the usual methods for treating them. -Knowledge of medical terminology, hospital routine and commonly used equipment. -Knowledge of acute hospital organization and the interrelationships of various clinical and diagnostic services. -Ability to effectively evaluate the medical records of hospital admissions regarding continuing stay necessity, appropriateness of setting, delivered care, use of ancillary services and discharge plans. -Ability to assess and judge the clinical performance of physicians and other health professionals. -Ability to communicate documentation needs in an effective and tactful manner that promotes cooperation. -Ability to teach co-workers what is needed and required in the medical record for reimbursement and audit purposes. -Ability to gather and analyze data and prepare reports and recommendations based thereon. -Ability to get along with physicians, other health providers, outside payor sources and the general public. Education:Required Education:-Highest level of education as stated on the resume.Required Certifications & Licensure:-Possession of a valid license as a Registered Nurse in the State of California.BLS/ CPR Card