Per Diem Registered Nurse II/III - Utilization Management VCMC

About the role

Scheduled as needed to assist with patient care coordination and utilization review. The incumbent will be responsible for assisting in the evaluation of patient care data in order to coordinate post-discharge needs of patients.

Responsibilities

• Plans, develops, assesses and evaluates care provided to patients;
• Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use;
• Recommends alternative levels of care and ensures compliance with federal, state and local requirements;
• Affords assessments high risk patients in need of post-hospital care planning;
• Develops and coordinates the implementation of a discharge plan to meet patient's identified needs;
• Communicates the plan to physicians, patients, family/caregivers, staff and appropriate community agencies;
• Reviews, monitors, evaluates and coordinates the patient's hospital stay to assure that all appropriate and essential services are delivered timely and efficiently;
• Participates in the Bed Huddles and carries out recommendations congruent with the patient's needs;
• Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families;
• Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient and non-KFH facilities;
• Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred;
• Refers patients to community resources to meet post hospital needs;
• Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation;
• Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: The Joint Commission (TJC), California Department of Health Services (DHCS), Centers for Medicare & Medicaid Services (CMS), and Department of Managed Health Care (DMHC);
• Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources;
• Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness;
• Reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities;
• Reviews, analyzes and identifies utilization patterns, trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities;
• Coordinates, participates and/or facilitates care planning rounds and patient family conferences as needed;
• Participates in committees, teams or other work projects/duties as assigned;
• Performs other duties as required.

Requirements

• Graduation from an accredited School of Nursing;
• Current, valid Basic Life Support (BLS/CPR) certification;
• Successful completion of the Health Care Agency Pharmacology examination within three (3) months of employment;
• Working knowledge of the theory, techniques, and practices of professional nursing within utilization management;
• Medical terminology and hospital routine and equipment;
• Medicines and narcotics;
• Working ability to plan and organize nursing care;
• Train and supervise non-professional staff;
• Establish and maintain confidence of patients and staff;
• Work effectively in different hospital departments on shifts as required.

Qualifications

• Per Diem RN II: Six (6) months of recent acute care nursing experience in an acute hospital setting;
• Per Diem RN III: Five (5) years of recent acute care nursing experience in an acute hospital setting;