Top 18 Utilization management nurse Jobs in Gridley, Ca

Registered Nurse Discharge Planner 10 Hr.
Oroville Hospital —Oroville, CA
- $66.16 - $92.47 an hour
- Weekends as needed
- Acute care
- Nursing
- Psychiatry
Director, Care Management - Full Time, Day Shift
Adventist Health —Marysville, CA
- $145,954 - $218,931 a year
- Full-time
- Medicine
- RN License
- Hospital
11d
Registered Nurse-ED
Colusa Medical Center —Colusa, CA
- Full-time
- RN License
- PALS Certification
- BLS Certification
Quick Apply
OP Psychiatric Clinic Manager
Oroville Hospital —Oroville, CA
- 8 hour shift
- Nursing
- Psychiatry
- RN License
Registered Nurse
Premier Home Health Providers Inc. —Yuba City, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
Remote Utilization Management Nurse (Inpatient Review – RN or LVN) MUST HAVE ACTIVE CALIFORNIA LIC.
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- Spanish
- Nursing
- Microsoft Excel
- Travel reimbursement
- Health savings account
Quick Apply

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utilization management nurse jobs near gridley, ca

Registered Nurse Discharge Planner 10 Hr.

Oroville Hospital -
Oroville, CA

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Job Details

Per diem
$66.16 - $92.47 an hour

Qualifications

RN License
BLS Certification
Emotional support for patients
Working with families

Full Job Description

Job Description

Registered Nurse Discharge Planner 10 Hr. 8755

Job #: 10699

Job Category: Nursing

Job Type: Per Diem

Shift Type: Variable

Department: Case Management

Pay Range: $66.16/hr. - $92.47/hr.

Open Date: 05.08.26

Close Date:

Qualifications:

Graduate of an accredited school of professional nursing and a current license with the California State Board of Registered Nursing
Current American Heart Basic Life Support (BLS), annual update of Safety, Clinical Competency and annual Interpreter Services

Job Details:

Start Date:

Open Until Filled.

Qualifications:

Graduate of an accredited school of professional nursing and a current license with the California State Board of Registered Nursing
Ability to interact therapeutically with patients, families, physicians, co-workers and community agencies
Ability to maintain confidentiality
High level organizational skills
Excellent communication skills
Current American Heart Basic Life Support (BLS), annual update of Safety, Clinical Competency and annual Interpreter Services
Demonstrate compassion and empathy with patients

Duties &
Responsibilities:

Job Summary

The registered nurse working in as a Discharge Planning Nurse is responsible for performing case management, utilization review, quality assurance, and discharge planning first.

Responsibilities specific to Discharge Planning includes assessment, identification of specific needs, and social service intervention or referral while in the acute setting. Awareness of services available to patients and their families are an important part of this assessment. Determining patient needs on basis of diagnosis; prognosis and social support system/person information are included in the initial assessment process. Upon individual recognition and staff referral, the discharge planner will contact the appropriate agency to meet the patient’s social, emotional and spiritual needs.

Responsibilities specific to Utilization Review include performing admission and concurrent review, and at times retro-review of all in-patients conforming to Medicare and Medi-Cal requirements. These review processes may be applicable also to Contracted Managed Care members who are patients in the acute/ extended care units of the hospital. Issuance of non-coverage letters at time of discharge to the acute/extended care patient is also considered part of the discharge planning process as specified by contracted Health Plans and HCFA.

Responsibilities specific to Quality Assurance include performing surveillance and data collection as directed for trend recognition and development of effective actions/plans.

Duties

Demonstrates professional responsibility in the role of Discharge Planner
Complies with personnel policies and hospital safety policies
Maintains confidentiality when interacting with patients, families, personnel and the public
Maintains compliance with State/Federal Guidelines and standards
Performs duties as prescribed by the Discharge Plan of the hospital and as directed by the Assistant Director Utilization Management.
Conforms to all requirements of Medicare
Conforms to all requirements of Medi-Cal
Keeps current on changing laws and requirements of Medicare and Medi-Cal
Reports any problems to the Assistant Director Utilization Management in a timely manner
Provides information in response to queries from the public, doctors’ offices, families and outside facilities
Provides case management, social services, utilization review and discharge planning daily and on weekends as scheduled or assigned by the Assistant Director Utilization Management
Performs morning work according to the written procedure and as directed and scheduled by the Assistant Director Utilization Management.
Reviews information on Medi-Cal/CMSP patients in assigned area(s) necessary for review to Medi-Cal field office according to written procedures daily
Participates in Continuing Education and other pertinent and appropriate learning experiences to maintain and increase personal and professional growth
Participates in current continuing education that is relevant to the field of expertise of current practice
Maintains clinical competency in the Discharge Planning /Case Mgt. /DCP field.
Utilizes work time appropriately to maximize productivity
Minimizes visiting with co-workers, personal telephone usage and avoids unnecessary absence from assigned work areas and tasks
Utilizes work space and equipment in an appropriate, professional manner to enhance patient outcome
Performs financial assessment to ascertain patients’ source of payment for in-patient stay to begin review process and obtain timely payment for services rendered by hospital
Begins initial discharge planning assessment within 24 hours of admission
Using scoring from initial assessment determines degree of discharge planning needed on an individual basis for each patient
Completes the assessment within 72 hours of admission for each patient. Completion of assessment includes interview with the patient, family or other caregivers, and also may utilize chart information from previous stays
Begins acuity assessment using Interqual criteria and standards to complete concurrent review requirements and continued acute stay as part of initial assessment
Enters daily review information on computer forms to document and assess need for continued acute stay
Makes additional notes and documents conversations with other members of inter-disciplinary team on computer charting forms. These notes may also include conversations with caregivers, families, and other support systems involved with the care of the patient
Refers patients not currently requiring acute or skilled nursing care for discharge with appropriate services to lower level of care, or placement in appropriate facility. Preparation may include speaking with the patient, family, physicians, therapists, nurses, supervisors, intake coordinators, residential care facility managers, insurance companies, reviewers, etc. Also arranges for acute to acute transfers
Physician orders and signatures on transfer sheets, financial verification, insurance approval and transfer permits will need to be obtained, and transportation arranged
Checks voice mail periodically throughout the day and before leaving each day. Handles insurance review requests and patient related calls and removes the messages in a timely manner
Does inpatient insurance reviews that are requested daily, utilizes the acuity assessment form and notes review outcomes, contacts and requests for further review times for follow-up
Provides intervention necessary as indicated by scoring guideline of Discharge Planning assessment. This begins the case management for each patient as indicated by need identified. Case Management/DCP of the acute patient may include, but is not limited to Social Service intervention by outside agencies, such as Adult Protective Services, Child Protective Services, Psychological counseling, or follow-up by either in house MSW/ Psychologist, or County/State provided psychiatric services. Home Health referral based upon patient/ family wishes or needs. Arranging help such as IHSS, or contracted help to allow the patient to remain in their own home, ordering of DME necessary for patient recovery or convenience as ordered by the physician. Services may also include arrangement of placement in either Residential Care Facility, Assisted Living or in Skilled Nursing Facilities based upon patient/ family wishes and doctors order. Discussion of the discharge plan is ongoing from day of admission with the patient, family, interdisciplinary team, and physician staff. DCP acts as a resource person for patients referred from physician’s offices. Evaluates and refers appropriate patients to Financial Counseling or appropriate agency for assistance in obtaining Medi-Cal coverage. Contacts the appropriate agency to meet the patient’s social, emotional and spiritual needs. Provides continuity of care as the level of care changes
Provides information regarding Advance Directives, assists in filling out the forms, and obtaining non-employed witnesses to complete the documentation of Advance Directives. Makes photocopies for the patient and places a copy in the chart or sends it to Medical Records for filing in the chart at any time
Enters all discharges on Discharge Planning Activity Log Sheets daily for statistical purposes. Indicates on log all pertinent information regarding patient activity prior to discharge such as DME, Home Health agency referral, etc.
Calls appropriate insurance companies for discharge review upon patient discharge. Makes appropriate notes to document final review given
Completes retro- review to insurance companies as directed by the Assistant Director Utilization Management.
Performs surveillance and data collection as directed for trend recognition and development of effective actions/plans
Assist with Nursing duties as assigned per Assistant Director Utilization Management.
Educate patients upon discharge using the teach back method.
Performs other duties as assigned

Organizational Expectations

Provides a positive and professional representation of the organization.
Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention.
Maintains hospital standards for a clean and quiet patient environment to maintain a positive patient care experience.
Adheres to infection-control policies and protocols.
Participates in ongoing quality improvement activities.
Maintains compliance with organization’s policies, as well as established practices, protocols, and procedures of the position, department, and applicable professional standards.
Complies with organizational and regulatory policies for handling confidential patient information.
Demonstrates excellent customer service through his/her attitude and actions, consistent with the standards contained in the Vision, Mission, and Values of the organization.
Adheres to professional standards, hospital policies and procedures, federal, state, and local requirements.

Other Info:

Functional Demands

Semi- Sedentary: Sits and walks throughout workday

Generally lifting objects not more than 25 lbs. and/or carrying objects weighing 10 lbs.

Available Shifts:

Per Diem Variable Shifts

Contact Name:

Human Resources

Contact Phone:

530-712-2137

Contact Email:

[email protected]

Apply Now

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utilization management nurse jobs in gridley, ca

Registered Nurse Discharge Planner 10 Hr.

Director, Care Management - Full Time, Day Shift

Registered Nurse-ED

OP Psychiatric Clinic Manager

Registered Nurse

Remote Utilization Management Nurse (Inpatient Review – RN or LVN) MUST HAVE ACTIVE CALIFORNIA LIC.

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