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Pediatrician / Utilization Management RN / California / Locum or Permanent
2 months ago
Job Summary:
Monarch HealthCare, a leading healthcare organization, is seeking a highly skilled Pediatrician / Utilization Management RN to join our team. As a key member of our Utilization Management team, you will play a critical role in ensuring the efficient and effective management of patient care.
Key Responsibilities:
- Facilitate the inpatient Utilization Management process, including in-network, out-of-network, case management, and discharge planning.
- Assist the Associate Director of Inpatient Management with UM/QM functions as necessary.
- Act as a facility liaison to promote cooperation and efficiency between the IPA and the facility.
- Coordinate, facilitate, and document comprehensive discharge planning.
- Ensure the appropriate utilization of in-network, capitated, and contracted specialists, providers, facilities, and vendors according to region and risk.
- Attend daily inpatient readmission review rounds and present cases to medical director(s), Case managers, and post-acute services.
- Facilitate out-of-network transfers to In-Network facilities.
- Work collaboratively with internal and hospital contract staff.
- Develop and maintain relationships with both network and Out-of-Network hospital UM and ER staff.
- Work directly with Monarch Hospitalists to develop and implement inpatient processes.
Requirements:
- Strong clinical knowledge and experience in pediatric care.
- Excellent communication and interpersonal skills.
- Ability to work effectively in a fast-paced environment.
- Strong analytical and problem-solving skills.
- Ability to maintain confidentiality and handle sensitive information.
What We Offer:
- A dynamic and supportive work environment.
- Opportunities for professional growth and development.
- A competitive salary and benefits package.
- A sign-on bonus of $5,000 for this position.
