FSH RN Discharge/Utilization Review Nurse

Fresno Surgical Hospital is an extraordinary hospital created entirely to deliver excellence and quality in surgical care to each patient. Our unique facility and staff provide a hospitality- inspired, healing environment unlike anything experience in a traditional hospital. Our commitment to innovation, shared values and excellence can be reflected in exceptional satisfaction scores from patients, physicians and staff.

Job Summary

Assesses, plans, implements and evaluates the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO or private insurance to cover their stay at various units. Discharge planning is coordinated with physicians, Nursing, patient and significant others who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers.

Salary Range: $42 -$56

Required Skills:

Minimum Education and Work Experience

• Completion of an accredited nursing program.
• 1-3 years of related acute healthcare experience.

Required Licenses/Certifications

• Current California Nursing License
• ACLS Certificate preferred
• BLS Certificate required
• CCM in Case Management preferred

Required Skills

• Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage
• Ability to maintain collaborative working relationships to ensure a positive and productive work environment.
• Ability to plan and prioritize work with frequent interruptions.
• Ability to provide exceptional customer service.
• Effective verbal and written communication skills.
• Knowledge and proficiency of hospital information technology applications.

Essential Functions

• Assesses all patients to identify needs, issues, resources and care goals.
• Communicates daily with admissions personnel regarding admissions and discharges to various units.
• Is knowledgeable of patient's financial status, diagnosis and discharge needs. Communicates with patients, family members and caregivers regarding the discharge needs of the patient and anticipated discharge plans.
• Coordinates CPS, APS, Social Service referrals, Hospice referrals, ordering and arranging delivery of DME, Home Health, and other support services needed by patients/families/caregivers.
• Documents discharge planning in an ongoing manner.
• Coordinates care through daily assessment and communication with all members of the healthcare team.
• Explores strategies to reduce LOS and resource consumption, and implements and documents results.
• Identifies need for and/or arranges and conducts patient care conferences when necessary to facilitate coordination of complex services or problems.
• Is knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage.
• Maintains current knowledge of resources available within the community, maintains supply of resource materials to be distributed to patients when needed.
• Is able to obtain other resources as needed.
• Makes referrals based on interdisciplinary criteria.
• Participates in the development and implementation of case management plans.
• Reviews and/or assists the Primary Care RN in the development of a plan of care to address assessed needs.
• Seeks consultation about cases presenting problems and/or when experiencing significant deviations from plan of care.
• Tracks, trends and reports variance analysis results and participates in quality improvement activities to reverse problematic issues.
• Other duties as assigned

Fresno Surgical Hospital complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date.