Discharge/Util Review Nurse

  • Fresno Surgical Hospital
  • 6125 N Fresno St. Fresno California 93710 United States
  • Posted: Mar 01, 2019
Full-time Allied Health

Job Description

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.

Reasonable Accommodation Statement


To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.

Minimum Education and Work Experience

  • Completion of an accredited nursing program.
  • One year of related healthcare experience.

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.

Required Licenses/Certifications

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

Minimum Standards

  •  Time & Attendance (see FSH Time & Attendance Policy)
  •  Professional Appearance (see FSH Dress Policy)
  • Staff meetings (90%)
  • Annual Requirements
    • Mock Code Blue (min. 2 per year if applicable)
    • PPD/TB Screen
    • Annual Competencies
    • Flu Vaccine
    • License/Certifications
    • Compliance Training

    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

    Physical Demands

    • Lift up to 10 pounds- up to 1/3 of time
    • Lift up to 25 pounds- up to 1/3 of time
    • Reach with hands and arms- 1/3 to 1/2 of time
    • Sit- 1/3 to 1/2 of time
    • Stand- 2/3 and more of time
    • Stoop, kneel, crouch or crawl- up to 1/3 of time
    • Talk or hear- 2/3 and more of time
    • Use hands to finger, handle or feel- 1/3 to 1/2 of time
    • Walk- 1/3 to 1/2 of time

     Work Environment

    • Body fluid exposure- Yes
    • Grasping: simple/light - Both (5-6 hours)
    • Grasping: firm/heavy- Both (5-6 hours)
    • Hearing- Ability to hear alarms on equipment
    • Hearing- Ability to hear instructions from physician/department staff
    • Hearing- Ability to hear patient call
    • Repetitive use of hands- Both (5-6 hours)
    • Risk of electrical shock- up to 1/3 of time
    • Typical noise level- Moderate Noise
    • Work near moving mechanical parts- up to 1/3 of time