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Job Summary:

Assesses, plans, implements and evaluates the needs of patients for discharge planning and utilization review. Coordinates discharge planning with physicians, Nursing, Social Services, patient and significant others who have an ongoing caring relationship with the patient. Reviews patient procedures and DRG status against criteria for Medicare, Medicaid, and other insurance coverage.

Experience, Education and Licensure Required:

  • Current Registered Nurse licensure in State of California.
  • Three years clinical experience working with medically complex patients.
  • Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.
  • One year of experience in acute hospital UR or discharge planning.

Skills and Abilities Required:

Basic computer knowledge

Ability to communicate effectively with patients, family, physicians and other staff.

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