Registered Nurse II/III/IV - QI Inpatient Program

Full Job Description

Duties may include, but are not limited to:

• Reviewing medical records to determine medical necessity for inpatient hospitalizations

• Liaising and communicating with inpatient hospitals and clinical teams

The ideal candidate will possess:

• Experience with Utilization Review

• Inpatient clinical experience

• Strong proficiency navigating several Electronic Medical Records simultaneously

• Working knowledge of Microsoft office (word, excel and outlook)

• Ability to type a minimum of 40 words per minute

• Excellent communication and organizational skills

Prior Registered Nurse experience working in psychiatric/behavioral health settings is essential.

Work Schedule:

• 9/80 schedule

• Some weekends may be required

Meet the Team!
Riverside University Health System – Behavioral Health is a leading provider of mental health and substance use services in Riverside County. With a dedicated team of professionals, including psychiatrists, clinicians, peer specialists, and paraprofessionals, RUHS-BH serves over 45,000 individuals annually.
We are committed to delivering culturally competent, evidence-based care across all ages. Our programs, including Mental Health Services, Substance Use Services, and the Public Guardian’s Office, address the diverse needs of our community.

At RUHS Behavioral Health, you’ll join a compassionate, innovative team where your skills make a real difference. We offer opportunities for growth, collaboration, and meaningful impact.

If you’re passionate about advancing your career while improving mental health in Riverside County, RUHS Behavioral Health is the place for you!
For more information, please visitwww.ruhealth.org/behavioral-health

Requirements

Review the clinical records of patients admitted to psychiatric inpatient facilities to determine if the documentation adequately supports medical necessity.Must have an in-depth knowledge of what symptoms, behaviors, factors and documentation meet the standards of medical necessity as defined by Title 9, Medi-Cal, the California Department of Health Care Services (DHCS) and other relevant regulatory agencies.Must be able to recognize and gather all the information needed to make a determination, to synthesize and conceptualize this information, to reference applicable medical necessity standards and to ultimately and independently come to a determination about whether medical necessity is present.Must be able to accurately and concisely document the clinical information that does or does not support medical necessity and the reasoning that resulted in the ultimate determination.Must learn to recognize instances when (s)he is unable to come to a definitive determination and when (s)he should seek consultation with a QI Inpatient psychiatrist.Must be able to knowledgeably discuss medical necessity standards with other nurses, psychiatrists, social workers, care managers, placement workers and other mental health personnel.

These discussions may occur through email, by phone or face-to-face.May attend treatment rounds at some inpatient facilities and provide immediate education and feedback to hospital staff.May provide formal training to inpatient staff or other parties and may assist in training new QI Inpatient RNs.While performing reviews for medical necessity, the RN must also evaluate for potential Quality of Care (QOC) issues.

QOC issues are present when suboptimal care is provided to a patient by inpatient staff members.

This requires the RN to be knowledgeable about what constitutes appropriate care by all of the various disciplines providing care to the patient, including familiarity with regulatory standards and “best practice” standards.

When the RN identifies a potential QOC issue, (s)he should consult with a QI Inpatient psychiatrist about what possible, if any, actions should be taken.Will participate in periodic audits of psychiatric inpatient facilities including ITF, PHF and fee-for-service hospitals.

An RN may be designated to lead one or more of these audits. Every three years QI Inpatient is itself the subject of an audit by DHCS.

The RN will prepare documents, data and presentations for this audit and will interact with the state auditors during their survey.May serve on various committees as directed by their supervisor, sometimes serving as chairperson.

This may include participation on the Plan of Correction (POC) Committee which meets periodically to assure that relevant standards are met and documented in anticipation of the triennial DHCS audit.Will not provide any direct patient care in their role as a QI Inpatient nurse.

However, it is necessary to have prior experience, preferably several years, working as an RN in a psychiatric inpatient facility.

Any prior experience working in quality improvement, utilization management or case management is a plus, but not a requirement. The RN will report to the Manager of QI Inpatient.

The Manager may direct the RN to perform other reasonable duties not enumerated above.

Qualifications Registered Nurse II ($42.87-$59.92/hr)Education: Successful completion of the education required to obtain a valid license to practice as a Registered Nurse in the State of California.

(A bachelor's degree from an accredited college or university in nursing or a health-related field may be required for some positions.)Experience: Completion of one year as a Registered Nurse in an acute care hospital, mental health setting, clinic outpatient setting, or healthcare agency program.

Experience gained as an Interim Permit Nurse may be credited toward meeting the required experience.

Evaluations and references must show proficiency of practice as a Registered Nurse.Registered Nurse III ($46.05-$68.49/hr)Education: Successful completion of the education required to obtain a valid license to practice as a Registered Nurse in the State of California.

Experience: Three years of full time experience as a Registered Nurse in an acute care facility, mental health facility, or community health agency with references and evaluations to show appropriate skill level.

(A bachelor's degree from an accredited college or university in nursing or national certification in a nursing specialty may be considered as a substitution for one year of the required experience.

A master's degree from an accredited college or university in nursing may be considered as a substitution for two years of the required experience.) Registered Nurse IV ($49.27-$72.26/hr)Experience: Six years as a full-time Registered Nurse.

Some positions may require two years in a specialty area.

A master's degree from an accredited college or university in nursing or a health-related field may be substituted for two years of the required experience.Knowledge of: Current principles, techniques and procedures used in professional nursing; medical terminology and patient care routine appropriate to clinical setting; medical instruments and equipment; the uses and effects of medicines and narcotics; community resources available to provide patient care and follow-up; federal, state and local laws and regulations governing professional aspects of nursing; identification of potential discharge needs; payor source documentation requirements and governmental regulations affecting reimbursement.Other RequirementsLicense/Certificate: Must possess and maintain a current valid license to practice as a Registered Nurse in the State of California.

Possession of valid Basic Life Support (BLS) certificates issued by the American Heart Association.

Possession of a valid California Driver's License may be required.Additional Working Knowledge Requirements for Mental Health Applicants: Current child, dependent adult, and elder abuse reporting laws; current involuntary detention and commitment laws related to mental health; involuntary psychotropic medication laws; and Tarasoff-duty to warn requirements.Ability to: Perform the full range of nursing duties and responsibilities in a patient care setting; plan, organize and implement nursing plans for patients; prepare and maintain concise and complete records and reports; establish and maintain effective working relationships with physicians, patients and co-workers; secure the cooperation of employees to work effectively together; keep abreast of developments in areas of nursing specialization; teaches, mentors and supervises others routinely; effectively prepare and present reports and recommendations both orally and in written form; evaluate the medical records of hospital admissions; provide recommendations regarding continued stay necessity; identify discharge needs; collect and evaluate data, draw conclusions and formulate recommendations.In Mental Health, ability to use individual professionally sound judgment to make complex decisions related to: triage; clinical assessments including biopsychosocial evaluation; integration of mental health, chemical dependency, and physical healthcare needs; potential suicidality; placement issues and necessary linkages and supports; and need for emergent psychiatric care and consultation.

Additional Information For questions regarding this recruitment contact the recruiter, Nicole Prado: nprado@rivco.org.