Utilization Review RN

Job Summary and Responsibilities

Position Summary:

 

As a RN Care Coordinator, you are responsible for overseeing the progression of care and discharge planning for identified patients requiring these services.

 

Every day you will leverage your expertise to provide individualized, comprehensive care, making critical assessments, performing skilled procedures, and meticulously implementing patient care plans. You'll collaborate seamlessly within an interdisciplinary team, contributing to a dynamic environment focused on optimal patient outcomes.

 

To be successful in this role, you will possess keen assessment skills, acute critical thinking, and a patient-first mindset, driven by a profound enthusiasm to help others. Your sense of urgency and dedication to excellence in a fast-paced environment will not only support patient recovery but also fuel your own career advancement.

• Performs this role to meet the individual's health needs while promoting quality of care, cost effective outcomes and by following hospital policies, standards of practice and Federal and State regulations.
• The position’s emphasis will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care toward optimal outcomes at the appropriate level of care.
• Advocates for the patient and family by identifying, valuing, and addressing patient choice, spiritual needs, cultural, language and socioeconomic barriers to care transitions. In addition,
• Strives to enhance the patient experience.

 

 

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Job Requirements

Required

• • Graduate of an accredited school of nursing.
  • Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience.
  • RN license in the state(s) covered is required. 
  • BLS required within 3 months of hiring

 

Preferred:

• • Bachelor's Degree in Nursing (BSN) or related healthcare field. 
  • At least five (5) years of nursing experience.
• Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred
  • Able to apply clinical guidelines to ensure progression of care.
  • Knowledge of managed care and payer environment preferred.
  • Must have critical thinking and problem-solving skills.
  • Collaborate effectively with multiple stakeholders
  • Professional communication skills.
  • Understand how utilization management and case management programs integrate.
  • Ability to work as a team player and assist other members of the team where needed.
  • Thrive in a fast paced, self-directed environment.
  • Knowledge of CMS standards and requirements.
  • Proficient in prioritizing work and delegating where indicated.
  • Highly organized with excellent time management skills.

Where You’ll Work

Mercy Medical Center Redding offers comprehensive health care to nearly 300,000 residents in a six-county region. It is one of only two Level II trauma centers, the only Level III Neonatal Intensive Care Unit (NICU) and the only Joint Commission-certified Advanced Thrombectomy-Capable Stroke Center north of Sacramento north of Sacramento. Mercy Medical Center Redding is a 266-bed regional medical center providing inpatient and outpatient services as well as specialized cardiovascular care, stroke care, orthopedics, neurological surgery, comprehensive cancer care, maternity care, and a robust robotic surgery program. In addition, the hospital’s network of care includes Mercy Home Health and Hospice and Dignity Health Connected Living. 

One Community. One Mission. One California