Utilization Management Nurse Specialist Rn Ii

LA Care Health Plan

Los Angeles, CA, US
Base: $88,854.00 - $142,166.00; bonus/equity: not ...
On-site
Utilization management and case review
Telephonic and onsite admission review
Medical referral coordination
L.A. Care Health Plan is the nation’s largest publicly operated health plan serving more than 2 million members with a mission to provide access to quality healthcare for vulnerable and low-income communities in Los Angeles County

Job Summary

  • L.A. Care Health Plan is the nation’s largest publicly operated health plan serving more than 2 million members with a mission to provide access to quality healthcare for vulnerable and low-income communities in Los Angeles County.
  • The Utilization Management Nurse Specialist RN II is responsible for coordinating medically necessary referrals, performing admission and concurrent reviews, and collaborating with healthcare providers and members to develop discharge plans.
  • L.A. Care offers a wide range of benefits including Paid Time Off, Tuition Reimbursement, Retirement Plans, Medical, Dental and Vision coverage, Wellness Programs, and Volunteer Time Off.

Matching Summary

L.A. Care Health Plan is the nation’s largest publicly operated health plan serving more than 2 million members with a mission to provide access to quality healthcare for vulnerable and low-income communities in Los Angeles County.

Salary

Base: $88,854.00 - $142,166.00; Bonus/Equity: Not specified; Benefits: Paid Time Off, Tuition Reimbursement, Retirement Plans, Medical, Dental and Vision, Wellness Program, Volunteer Time Off

Skills & Requirements

Must-have

  • Utilization management and case review
  • Telephonic and onsite admission review
  • Medical referral coordination
  • Data collection and medical record transfer
  • Provider communication and inquiry handling
  • Discharge planning collaboration

Nice-to-have

  • Knowledge of NCQA requirements
  • Experience with Managed Medi-Cal and Medicare
  • Customer service and interdisciplinary communication
  • Time management and priority-setting skills
  • Knowledge of DHCS and CMS compliance

Key Requirements

  • Active, current and unrestricted California RN license
  • At least 5 years RN clinical experience in acute hospital setting
  • At least 2 years Utilization Management or Case Management experience
  • Associate's Degree in Nursing required
  • Preferred Bachelor's Degree in Nursing
  • Preferred Certified Case Manager (CCM) certification

Work Rights

Not specified

Tailored Resume

Cover Letter