Screens all admissions, verifies insurance coverage/ authorization, appropriateness of admission and compliance with admission criteria.
• Identifies documents and monitors intensity and severity of illness of patient population using InterQual Criteria 24-72 hours post notification of admission.
• Monitor’s patients care by reviewing physician orders, test/ lab results and nursing care
• Communicates verbally and/ or in writing with physicians regarding documentation needs, discharge plans, and over utilization of resources including length of stay.
• Communicates plan and coordination of the plan of care/ discharge plan with patient’s and patient’s families
• Monitors delay in service and avoidable patient days; works with department managers, physicians and nursing staff to eliminate delays in service and significantly decrease avoidable patient days.
• Monitors managed care patients to ensure appropriate utilization and to facilitate timely and appropriate discharge/ transfers.
• Document utilization review on Medi-Cal population on Treatment Authorization Request (TAR) forms
• Coordinates and assist in facilitating a smooth transition for patient transfer to other units, lower level of care or discharge.
• Facilitates or ensures appropriate referrals are made to Social Service, Hospice, Home Health, CCS, ect.


Fast pace 30 patient ratio to 1 RN CM, schedule by unit
Computer system is soft med but moving to intercore
Prefer bilingual Spanish
45% medical,20% Medicare, 10% cash patients, the rest is HMO