Aug 26, 2019

Utilization Review RN Case Manager, FT 80

  • Saint Agnes Medical Center
  • Fresno, CA, USA
Full time

Job Description

Reporting to the Manager, Care Coordination & Social Services, Social Services, this position coordinates utilization review service for defined patient populations across the acute care continuum. This includes discharge planning, utilization management, care coordination collaboration, and support for resource utilization. This position works collaboratively with an interdisciplinary team to improve patient care through the effective utilization of the facility's resources.

1. Current licensure as a Registered Nurse in the state of California is required.
2. Current American Heart Association (AHA) Healthcare Provider CPR card is required.
3. A degree from an accredited baccalaureate nursing program is preferred.
4. CCM national certification is preferred.
5. Interqual training must be obtained within six months of hire into position.
6. Previous experience in at least two areas of clinical specialty in an acute care setting is required.
7. Excellent communication skills, critical thinking, creative problem-solving skills, and competent organizational and planning skills are required.
8. The incumbent must be self-directed and able to tolerate frequent interruptions with a demanding workload.
9. Knowledge regarding hospital protocol and procedures, clinical standards and outcomes, funding options, familiarity with community resources and outside professional agencies, familiarity with federal and state regulations governing hospital and home care, as well as understanding of the financial structure of health plan and delivery system is preferred.