Utilization Review Nurse

AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!

Does the idea of doing something that really makes a difference in people?s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees? If so, AIDS Healthcare Foundation is the place for you!

Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.

STILL INTERESTED? Please continue!

AIDS Healthcare Foundation is currently seeking a Utilization Review Nurse to join our Managed Care division. The UR Nurse performs pre-admission, concurrent and retrospective acute care, sub-acute, hospice, and transitional care reviews to determine whether or not an admission is, or remains to be, reasonable and medically necessary using established criteria, e.g., Milliman and Robertson, InterQual or AHF Best Practice criteria.

This position is based out of our Linn House Administrative office:
1001 N Martel Ave., in West Hollywood, California 90046. The hours are Monday-Friday, from 9am-6pm.

JOB DESCRIPTION

Essential Duties & Responsibilities
Includes the following. Other duties may be assigned.

- Performs case reviews in a timely manner with case notes in the appropriate database.

- Issues initial PHC acute care Treatment Authorization Request (TAR) and each subsequently approved extension.

- Collaborates with the Primary Care Provider and/or attending physician, internal and external case managers, and other appropriate health care team members to provide continuity and quality of care in the most cost effective manner.

- Assists in the discharge planning process with both internal and external case managers/ discharge planners

- Concurrent Review and collaboration with internal case managers of all acute care, skilled nursing, acute rehabilitation, long term care, hospice and home with home care services admissions

- Assesses each acute care hospital admission to determine the appropriate level of care, i.e., critical care, telemetry, step down, medical-surgical, administrative, etc.

- Performs Admission Review within 24-48 hours of admission

- Monitors and maintains Length of Stay Reports

- Attends In-Patient Rounds at the Plan?s Preferred Hospitals

- Identifies and reports ?Lag Days? and variances to the Director of Utilization Review and Case Management

- Coordinates closely with the Plan?s Medical Director, referring cases that do not appear to meet established criteria

- Compiles and analyzes data for utilization review management activities

- Maintains logs and statistics.

- Reviews and issues Prior Authorizations for AHF and PHC Pharmacy Services Program

- Prepares and distributes weekly, monthly, quarterly and yearly utilization review reports

- Prepares Ad hoc reports upon request

- Prepares an annual Utilization Review Program evaluation

Participation in AHF Meetings/Committees
Attends AHF meetings as assigned.

Supervisory Responsibilities
This job has no supervisory responsibilities.

Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience
Graduate from an accredited RN Program with 3 or more years of recent medical/surgical or HIV/AIDS nursing experience and 3 or more years of recent Utilization Review/Case Management experience.

Computer/Software Skills & Abilities
To perform this job successfully, an individual should have knowledge of Contact Management systems, Word processing software, and Spreadsheet software.

Other Skills & Abilities/Qualifications
- Strong telephonic skills for reviews.
- Ability to successfully work with various levels of professional staff
- Must be able to work independently and as part of a team.
- Knowledge of HIV/AIDS and related medical and patient care issues and concerns in diverse populations.

Certificates, Licenses and Registrations
Current California RN License.

Are you intrigued by this amazing opportunity? Are you eager to learn more? If so, please send your resume via e-mail to: Careers@aidshealth.org or fax it to: (323) 417-5030. To apply in person please come to our Administrative Office: 6255 Sunset Blvd., 21st. Floor, Los Angeles, CA 90028.

Additional Information
Salary: Based on Experience
Position Type: Full Time, Employee
Reference Code: 0705 UR Nurse / Linn House Administrative Office

Contact Information
David Marin
Senior Recruiter
AIDS Healthcare Foundation
6255 W. Sunset Blvd., 21st. Floor
Los Angeles, CA 90028
Fax Number: (323) 417-5030
Email: Careers@aidshealth.org

We look forward to hearing from you!