SUMMARY The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources. RESPONSIBILITIES AND DUTIES: • Coordinates and reviews all medical records, as assigned to caseload. • Actively participates in Case Management and Treatment Team meetings • Serves as on-going educator to all departments. • Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from fiscal intermediary; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting • Able to work independently and use sound judgment. • Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment. • Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families. • Performs other duties as assigned. This position is a mid-shift (3pm - 11:30pm) and will need to work on weekends. EDUCATION & EXPERIENCE REQUIREMENTS: • Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred. • CA RN License Required • Minimum of 2 years' experience with the population of the facility and previous experience in utilization management preferred. SKILLS & ABILITIES REQUIREMENTS: • Communication • Planning & Organizing • Problem Solving • Attention to Detail PHYSICAL REQUIREMENTS: • Body Positions: Sitting and standing for prolonged periods. • Body Movements: Arm and hand dexterity. • Body Senses: Must have command of close and distant sight, color perception and hearing. • Strength: Ability to lift and move up to 25-pounds. Working Environment: • Work in an office, where the climate is controlled. • OSHA exposure category: I • Category I – Position includes tasks that involve exposure to Blood borne Pathogens. • Category II – Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks. • Category III – Positions includes tasks that do not involve exposure to Bloodborne Pathogens. This position would not be required to perform Category I tasks.