Utilization Review Nurse - Part Time - Shift

$43.51 - $68.56 / hour

Kern Medical has been a community cornerstone since its founding in 1867. Today, we are an acute care teaching center with 222 beds, offering the only advanced trauma care between Fresno and Los Angeles. Kern Medical offers a range of primary, specialty, and multi-specialty services including high-risk pregnancy care, inpatient psychiatric services integrated with county mental health programs, and a growing network of outpatient clinics providing personalized patient-centered wellness care. Kern Medical cares for 15,500 inpatients and 125,000 clinic patients a year.

Career Opportunities within Kern Medical include many benefits such as:

New Hire Bonus: $6,000.00
New Hire Premium: +6% of base rate of pay, matched up to 6% if contributed to Deferred Compensation Plan.
A Comprehensive Benefits Package: includes Holidays, Paid Time Off, Retirement, Medical, Dental, Vision and Life Insurance.

Position: Utilization Review Nurse - Case Management

Compensation:

The estimated pay for this position is $43.5114 to $68.5608 per hour. The rates shown include a 6% premium pay (base= $-$ plus 6%). This reflects only a portion of the total compensation package for this position. Additional compensation may be available for this role through differentials, incentives, and bonuses. In addition, this position may be eligible for participation and company contributions into the Kern County Employees’ Retirement Plan.

Distinguishing Characteristics:

Positions in this classification are assigned to the Utilization Review division of Kern Medical Center. Incumbents perform clinically oriented medical chart reviews and other administrative tasks to meet the requirements of the medical center's utilization review plan, state and federal regulations, insurance company requirements for reimbursement and facility accreditation standards. The Utilization Review Nurse classification ranges from less experienced nurses, who will perform administrative tasks concerning Utilization Review and Discharge planning activities, to experienced nurses who will apply full working knowledge of applicable regulations and to develop knowledge of outside agencies and services to develop appropriate discharge plans.

Essential Functions:

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.
Answer questions from providers regarding reimbursement, prior authorization and other documentation requirements.
Learns the documentation requirements of payor sources to maximize reimbursement to the hospital
Initiates and completes Disease Related Groups (DRG's) for Medicare payment; answers questions from providers regarding reimbursement, prior authorization and other documentation requirements.
Teaches providers the documentation requirements of payor sources to maximize reimbursement to the hospital.
May assist in training of other Utilization Review Nurses.
Keeps informed of patient disease processes and treatment modalities.

Other Functions:

Performs other job related duties as required.

Employment Standards:

Possession of a valid license as a Registered Nurse in the State of California

AND

Two (2) years of experience or its equivalent as a registered nurse in an acute care hospital, at least one of which was on a medical/surgical ward or unit.

Possession of a valid license as a Registered Nurse in the State of California and two (2) years of experience as a Case Manager in an alternate medical setting such as a clinic or physician’s office performing utilization or discharge planning.

Incumbents may be required to possess and maintain specific certificates competency based on unit specific requirements as a condition of employment.

Appointees not possessing the American Heart Association Provider Basic Life Support (BLS) card at time of hire must successfully complete appropriate training and qualify for the RQI Provider certification within 60 days of employment. As a continued condition of employment, employee must maintain RQI Provider certification and competency.

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 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.

Supplemental:

A background check may be conducted for this classification.

All Kern County employees are designated "Disaster Service Workers" through state and local laws (CA Government Code Sec.3100-3109 and Ordinance Code Title 2-Administration, Ch. 2.66 Emergency Services). As Disaster Service Workers, all County employees are expected to remain at work, or to report for work as soon as practicable, following a significant emergency or disaster.

If position responsibilities require driving a personal vehicle, then possession of a current valid California Driver’s License and adherence to the Kern County Hospital Authority Vehicle Use and Driving Standard Policy (ENG-EC-119) is required.

If position responsibilities require driving a vehicle owned, leased or rented by Kern Medical, then possession of a current valid California Driver’s license, a signed authorization for Release of Drivers Record Information and adherence to the Kern County Hospital Authority Vehicle Use and Driving Standard Policy (ENG-EC-119) is required.

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Kern Medical Bakersfield, CA

$41.05 - $64.68 / hour

Kern Medical has been a community cornerstone since its founding in 1867. Today, we are an acute care teaching center with 222 beds, offering the only advanced trauma care between Fresno and Los Angeles. Kern Medical offers a range of primary, specialty, and multi-specialty services including high-risk pregnancy care, inpatient psychiatric services integrated with county mental health programs, and a growing network of outpatient clinics providing personalize patient-centered wellness care. Kern Medical cares for 15,000 inpatients and 125,000 clinic patients a year. Per Diem employees supplement department staffing needs, with no guarantee of minimum hours. Must be willing and available to work four (4) shifts per six (6) week scheduling period. Position: Registered Nurse - Operating Room - Per Diem - Shift Compensation: The estimated pay for this position is $41.0485 to $64.6800. This reflects only a portion of the total compensation package for this position. Additional compensation may be available for this role through differentials, incentives, and bonuses. Distinguishing Characteristics: This classification ranges from novice nurse with limited knowledge and skills to expert nurse with advanced knowledge and skills, and the ability to perform work with minimum supervision. It is designed to accommodate the expanding experience of the Registered Nurse (RN) resulting in the ability to orient nurses with limited experience and re-entry nurses to current clinical practice. The HSN is expected to be committed to enhancing the profession of nursing, actively seek to improve their professional practice, contribute to the professional development of others, demonstrate caring-healing practices and promote the vision and goals of the organization and Department of Nursing. All nursing clinical practice will be evaluated and governed through the Chief Nursing Officer (CNO) and/or their RN designee. Essential Functions: Creates and sustains an environment that supports compassionate caring through authentic presence with the patient and family, building trusting relationships, creates connections that embrace mind, body, spirit modalities to mobilize the patient’s strengths and abilities toward healing. Collects and documents data for assigned patients according to prescribed methods. Interprets assessment data to determine whether patient has physiological and/or psychosocial risk factors, records and reports variances from normal parameters. Collaborates with the patient, family and members of the healthcare team to develop individualized plan of care based on existing and potential patient problems, observable patient responses. Implements nursing and physician orders safely Uses education, experience and interpretation of assessment data to prioritize appropriate nursing actions; Establishes nursing diagnoses, uses appropriate resources to formulate a written plan of care; evaluates the effectiveness of nursing interventions and revises patient care plans, as necessary. Anticipates and effectively manages rapidly changing situations by rapid grasp of changes in patient status and problem situations. Prioritizing and responds quickly and appropriately to identify the need for and activation of emergency protocols and assistance. Performs and documents the nursing process consistent with scientific principle and hospital policy as required by patient assignment using critical thinking and nursing judgment. Implements the medical and nursing care plans and coordinates patient care activities with nurses, physicians and Advanced Practice Providers. Partners with the patient/family to assess learning needs, priorities and level of understanding and co-develops plan. Designs teaching methods and plans accordingly; follows through on teaching plans developed to instruct patients and their family members regarding; testing, procedures and disease process; knowledge and skills essential to coping with illness, and promotion of optimum health. Coordinates and participates in patient care rounds and conferences. Understands team dynamics and collaborates effectively within the care team. Contributes to team building through participation in unit programs and meetings; contributes to positive morale, using constructive and effective conflict resolution skills. Assists with training staff members and orienting new staff; works collaboratively with clinicians to manage patient care. Assures quality of care by adhering to therapeutic standards and evidence-based practices, measuring outcomes against patient care goals and hospital or regulatory standards. Provides safe care to patients and protects employees by adhering to approved infection control policies and protocols, medication administration and storage procedures and controlled substance regulations. Participates in staff meetings, professional governance councils (unit or organizational level), evaluation and standards development for nursing practice, nursing recognition and well-being activities. Completes all competencies, mandatory classes and educational coursework as required by the Department of Nursing. Attains knowledge and competence that reflects current nursing practice. Demonstrates commitment to lifelong learning. Adheres to hospital-approved policies and procedures. Adheres to RN scope of practice, as defined by BRN licensure. Is knowledgeable of and is compliant with ANA Code of Ethics, ANA Scope and Standards of Practice, and KMC Professional Practice Model Monitors own practices and assists in monitoring others for practices related to patient and employee safety and compliance to standards and policies. Looks for opportunities for continual improvement in patient care and the work environment. Demonstrates clinical knowledge and skill in the care of populations served by Kern Medical facilities. Other Functions: Performs other job-related duties as assigned. Trains staff members, orients new staff and serves as a mentor to staff as an experienced clinician and manager of care. Employment Standards: Graduation from an accredited registered nursing program with a Bachelor or Associate’s degree preferred, and a valid and unrestricted license issued by the State of California to practice as a Registered Nurse; Minimum one (1) year of Registered Nursing experience in area applying. Employees must maintain all health requirements designated by Kern Medical Center. Possess and maintain a current American Heart Association Healthcare Provider Basic Life Support (BLS) card. Depending on assignment, incumbents may be required to possess and maintain specific certificates of competency or complete designated education as a condition of employment. Knowledge of: Theory, techniques and practices of nursing; medical terminology, instruments and equipment; the uses and effects of medicines and narcotics. Skill in: Following oral and written instruction and maintain concise and complete records. Demonstrate the practical and theoretical knowledge of nursing care specific to the assigned work area/specialty; meet the content and performance criteria specific to each defined specialty, including the nursing process, leadership/professional development, and unit operation; demonstration of standard techniques of record maintenance and report writing; using computers and related software applications; keyboarding and using standard office equipment; follow oral and written instruction; communicate both orally and in writing sufficient to exchange or convey information and to receive work direction; prepare and maintain concise and comprehensive required records and reports; establish and maintain effective work relationships with staff, other hospital employees, patients and their families; dependent upon area of practice or department assignments, demonstrates clinical knowledge and skill in the care of populations served by Kern Medical facilities. Supplemental: A background check may be required for this classification. All Kern Medical employees are designated “Disaster Service Workers”. In the event of a disaster or civil disorder, all Kern Medical employees are to remain at work or to report to work in a safe and practicable manner. If position responsibilities require driving a personal vehicle, then possession of a current valid California Driver’s License and adherence to the Kern County Hospital Authority Vehicle Use and Driving Standard Policy (ENG-EC-119) is required. If position responsibilities require driving a vehicle owned, leased or rented by Kern Medical, then possession of a current valid California Driver’s license, a signed authorization for Release of Drivers Record Information and adherence to the Kern County Hospital Authority Vehicle Use and Driving Standard Policy (ENG-EC-119) is required.