LVN DSD Utilization Review, Skilled Nursing - Fresno, United States - Community Medical Centers

Description

*All positions are located in Fresno/Clovis CA*

Opportunities for you

• Join a Forbes Top 10 CA Employer
• Direct impact on quality patient care.
• Time and a half after 8 hrs + weekend and night differential (call pay for procedural areas).
• Free Continuing Education and certification including BLS, ACLS and PALS
• Tuition reimbursement, education programs, and scholarships
• Vacation time starts building on Day 1, and builds with your seniority
• 403(b) retirement plan with up to 8% matching contributions
• Free parking and electric charging
• Great food options with on-demand ordering

Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community.

We know that our ability to provide the highest level of care begins with taking care of our incredible teams. Want to learn more? Click here.

The LVN DSD-Utilization Review is responsible for supporting Community Subacute Transitional Care Center (CSTCC) Patient Care Representatives clinically to meet activities from internal and external sources. Works collaboratively with the interdisciplinary team, other departments, and physicians to facilitate efficient and appropriate management of all cases. Assists in reviewing and auditing patient case data to ensure quality care and cost effectiveness. Participates in new hire orientation and competency evaluation coordination. Plans, implements, directs, evaluates the educational program of all personnel in the facility based on identified resident needs, staff needs, Federal and State regulations.

Accountabilities

1. Collaborates with Nursing Manager and DON/Administrator in the development, implementation of policies and procedures that govern the nursing services in collaboration with appropriate services.
2. Directs, conducts the orientation of new employees according to regulations which includes, but is not limited to, philosophy, objectives of care, resident rights, safety, infection control and policies and procedures of the facility.
3. Plans and conducts meaningful in-service education programs according to regulatory requirements for nursing personnel and all facility staff to assure competency in existing and new skills as directed by the Administrator and/or Director of Nursing.
4. Maintains an annual calendar and post a monthly calendar of in-services for all staff.
5. Maintains records of in-service hours for all employees.
6. Responsible for oversight and training of all Certified Nursing Assistants.
7. Assesses competency of all nursing staff on an annual basis and provides additional instruction in deficient areas. Establishes, maintains nursing services personnel competency files.
8. Verifies and monitors that patient admission status is appropriate.
9. Performs concurrent and retrospective review for commercial payers, submitting clinical patient information to obtain approval of days and facilitate timely reimbursement.
10. Collaborates, when appropriate, with payer case managers (i.e., Worker's Comp, commercial payer case manager).
11. Provides clinical support for UR service requests. Completes appropriate documentation in UR software program and submits written performance activity logs of daily Utilization Review Specialist activities to manager.
12. Documents correspondences, authorizations, and patient information into the electronic health record (EHR), including all data needed for further action or follow up.
13. Selects appropriate chart documents to submit timely requests to insurances, private health plans, medical groups and IPAs to secure authorizations. Identifies authorization issues and brings those requiring attention to Patient care representatives, Admission Coordinator and Nursing Managers.
14. Assists Patient Care Representatives in tracking concurrent service authorizations, denials, and authorization gaps. Contacts third party payors for follow up on missing authorizations and securing authorizations when necessary.
15. Supports departmental initiatives by following policy and procedure, assists with MediCal TAR Free audit preparation, and updates.
16. Participates in licensed personnel meetings on a regular basis and in meetings as needed for department support.
17. Facilitates communication within Revenue Cycle and Utilization Review.
18. Performs other duties as assigned.

Education

• High School Diploma, General Education Development (GED) or Completion of a CMC Approved Individualized Education Plan (IEP) Certificate required

• Completion of an accredited Vocational Nursing School program OR become licensed by equivalency required

Experience

• 6 months of experience in a long term care facility required

Licenses and Certifications

• LVN - Current State of California Licensed Vocational Nurse License required

• BLS - Current Basic Life Support (BLS) for Healthcare Providers by American Heart Association (AHA) required

• DSD - Certified Director of Staff Development required within 180 days of hire or transfer into position

• Pay ranges listed are an estimate and subject to change.

• If any bonuses are noted, they are only applicable to external hires meeting criteria.