Job Summary:Under general Utilization Review administrative staff supervision, abstracts data from Utilization Review Nurses reports regarding patients who have been denied continued hospital stay admission; enters data into computer in appropriate format, and retrieves information for distribution to California Medical Review, Inc. and designated staff members; sends required forms to CMRI; assists in coordination and preparation of record for CMRI on-site/off- site review; provides clerical support, to include word processing, to the Utilization Managements staff.Essential Responsibilities:
Abstracts data from Utilization Review Nurses reports regarding patients who have been denied continued acute hospital stay; enters data into computer in appropriate format; retrieves computer reports and distributes copies to Director, Utilization Review, Hospital Records Administrator, Utilization Review Committee, and California Medical Record Review, Inc.
Maintains records and files for reference and documentation purposes, for both manual and computerized records.
Obtains and reviews admission/discharge lists, census reports, and Medicare patient lists from appropriate departments to ensure accurate monitoring of patient activity; prepares and updates Utilization Review worksheets including level of care rationale; sends required forms to CMRI; assists in coordination and preparation of records for CMRI on site-review.
Complies (by entering and formatting data into computer) and distributes a variety of monthly statistical reports in accordance with established time frames.
Requests, pulls and re-files medical records as needed for review by Utilization Review/Pre Admission Coordinators, outside agencies, and others.
Provides clerical support, including word processing, to the Utilization Management staff; orders supplies; processes office/equipment repair request to Plant Engineering, construction and vendors; answers phones and relays messages; photocopies.
Keeps abreast of current governmental rules, regulations, and interpretations affecting the hospitalization of Federally-insured patients and the record keeping required by governmental agencies.
Makes arrangements for monthly Utilization Review Committee meetings and other department meetings as requested, establishing date with manager and designated staff and assisting with completion of agenda, ordering lunch/refreshments and taking minutes at meeting.
Assists in other projects as directed; performs other related duties as required.
Basic Qualifications:Experience
N/A.
Education
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A
Additional Requirements:
General understanding of medical records functions, aptitude for mathematics and good communication skills required.
Knowledge of medical terminology.
Ability to file both alphabetically and terminal digit.
Typing at 45 wpm. All testing must be completed within the last year or by the end of the posting period.
Must be able to work in a Labor/Management Partnership environment.
NOTE: Education/License/Certification and Qualifications required for Moreno Valley Community Hospital employees acquired through Kaiser Permanentes purchase of Valley Health Systems Moreno Valley Community Hospital: Employees shall meet the minimum position qualifications as listed on their previous Valley Health System job description.
Preferred Qualifications:
Utilization review clerical experience preferred.
Computer experience preferred (data entry, data base and word processing programs).
Notes:
Every other weekend.
COMPANY: KAISERTITLE: Outside Case Management ClerkLOCATION: Moreno Valley, CaliforniaREQNUMBER: 1270814External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.