注册护士，护理经理，利用管理
RN, Care Manager, Utilization Management
位于萨克拉门托都会区，安德森医疗公司总部自40多年前以来一直位于加利福尼亚州罗斯维尔。2019年，我们推出了符合WELL认证的园区——一个让全系统员工协作、创新和连接的焕新场所。
无论是在虚拟还是校园环境中，安德森医疗罗斯维尔及共享服务团队都能享受到一个促进健康并激发最佳工作的欢迎空间。
职位概要：
在确保患者获得高质量护理的同时，高效利用医疗资源方面发挥关键作用。审查患者病历，评估拟议治疗的适当性和必要性，并与医疗提供者和保险公司合作，确保无缝的护理体验，实践财务责任和拒绝预防。专注于最大化患者结果和优化资源配置。运用卓越的临床知识、优秀的沟通技巧以及在快节奏且不断变化的医疗环境中茁壮成长的能力。
职位要求：
教育和工作经验：
- 护理副学士学位或同等教育/相关经验：必需
- 护理学士学位（BSN）：优先考虑
- 需要有五年急性医院经验，优先考虑重症监护领域经验：必需
- 在过去12个月内使用Optum/Inter Qual产品进行过两年的利用审查：必需
执照/认证：
- 在执业州持有注册护士（RN）执照：必需
核心职责：
- 使用Optum/Inter Qual工具对急性医学患者进行临床审查，以确定患者是否处于正确的急性护理环境，是否接受正确的急性服务，在适当的住院时间内。
- 参与年度Optum/Inter Qual培训。按照年度部门目标中规定的最低通过分数完成年度Optum/Inter Qual Interrater Reliability（IRR）测试。
- 在完成入职培训后的90天内满足每周生产率指标，并按照年度部门目标中定义的要求每周保持。在完成入职培训后的90天内满足质量审计指标，并按照部门中定义的审计频率保持。
- 按时完成所有指定的部门教育课程，并达到要求的标准。
查看英文原文
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Plays a critical role in ensuring that patients receive high-quality care while efficiently utilizing medical resources. Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments, and collaborating with healthcare providers and insurance companies to ensure a seamless care experience and the practicing of financial stewardship and denial prevention. Focuses on maximizing patient outcomes and optimizing resource allocation. Utilizes exceptional clinical knowledge, excellent communication skills, and the ability to thrive in a fast-paced and ever-changing healthcare environment.
Job Requirements:
Education and Work Experience:
- Associate’s Degree in nursing or equivalent combination of education/related experience: Required
- Bachelor's Degree in Nursing (BSN): Preferred
- Five years' acute hospital experience required with preferred experience in critical care areas: Required
- Two years' utilization review experience using the Optum/Inter Qual product within the last 12 months: Required
Licenses/Certifications:
- Registered Nurse (RN) licensure in the state of practice: Required
Essential Functions:
- Completes clinical reviews of acute medical patients using the Optum/Inter Qual tool to determine if the patient is in the right acute setting, receiving the right acute services, during the appropriate length of stay.
- Participates in annual Optum/Inter Qual training required. Takes the required annual Optum/Inter Qual Interrater Reliability (IRR) test with a minimum passing score as defined in the yearly departmental goals.
- Meets weekly productivity metrics within 90 days of completing orientation and maintains on a weekly basis as defined in the yearly departmental goals. Meets quality audit metrics within 90 days of completing orientation and maintained on the audit cadence set within the department as defined in the yearly departmental goals.
- Completes all required departmental education assigned with timeliness and accuracy. Follows all departmental workflows in communication variances to the on-site care management teams when appropriate. Reviews and analyzes medical records to assess the necessity and appropriateness of treatments and interventions.
- Collaborates with healthcare professionals to develop and implement comprehensive patient care plans. Facilitates communication between the patient, healthcare team, insurance providers, and other stakeholders to ensure a coordinated and efficient care process. Stays up to date with the latest healthcare regulations, insurance guidelines, and evidence-based practices to ensure the delivery of optimal healthcare services.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
Originally posted on Himalayas