Nurse - Pediatric Utilization Management Specialist

2 weeks ago


Irvine, California, United States OptumCare Full time
OptumCare is a leading organization in the health care sector, providing extensive support to physicians and health care professionals. Our network offers a wide range of resources, including specialists, hospitals, and urgent care facilities, ensuring optimal health outcomes for our patients.
The Role of Utilization Management RN involves overseeing the inpatient Utilization Management process, which includes both in-network and out-of-network services, case management, and discharge planning. This position serves as a vital link between the Independent Practice Association (IPA) and the facility, promoting collaboration and efficiency.

This is an office-based role that may require occasional travel within the region.

Key Responsibilities:
  • Conduct concurrent reviews to ensure appropriate care levels
  • Document and identify levels of care accurately
  • Facilitate comprehensive discharge planning
  • Coordinate in-network services for patients discharged out of network
  • Ensure effective utilization of specialists and facilities
  • Participate in daily rounds, presenting cases to medical directors and case managers
  • Manage out-of-network transfers to in-network facilities
  • Collaborate with internal and hospital staff on various initiatives
  • Build and maintain relationships with hospital UM and ER staff
  • Work with hospitalists to enhance inpatient processes and referrals
  • Engage in meetings and projects related to UM and quality improvement
At OptumCare, you will be recognized for your contributions in a dynamic environment that fosters professional growth and development.

  • Irvine, California, United States OptumCare Full time

    OptumCare is a leading organization that encompasses a vast network of healthcare professionals dedicated to enhancing patient care. Our extensive network provides access to a wide range of specialists, hospitals, and urgent care facilities, ensuring optimal health outcomes for our patients. The Pediatric Utilization Management RN plays a crucial role in...


  • Irvine, California, United States OptumCare Full time

    OptumCare is a leading network of healthcare professionals dedicated to enhancing patient outcomes in the community. Our extensive network provides access to a wide range of specialists, hospitals, and urgent care facilities, ensuring comprehensive health solutions for our patients. The Pediatric Utilization Management RN plays a crucial role in overseeing...


  • Irvine, California, United States OptumCare Full time

    About OptumCare:OptumCare is a leading organization dedicated to enhancing patient health and optimizing healthcare delivery. Our extensive network in Orange County and Long Beach connects you with a variety of specialists, hospitals, and urgent care facilities, ensuring comprehensive health solutions.Position Overview:The Utilization Management Registered...


  • Irvine, California, United States OptumCare Full time

    OptumCare is a leading organization in the health care sector, providing a vast network of physicians and health care professionals. Our extensive network ensures access to specialists, hospitals, urgent care, and more, facilitating optimal health outcomes. The Role of Utilization Management RN involves overseeing the inpatient Utilization Management...


  • Irvine, California, United States OptumCare Full time

    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...


  • Irvine, California, United States OptumCare Full time

    OptumCare is a leading organization in the health care sector, providing a vast network of physicians and health care professionals. Our extensive resources allow for seamless access to specialists, hospitals, and urgent care facilities, ensuring optimal health outcomes for our patients. The Role of Utilization Management RN involves overseeing the...


  • Irvine, California, United States OptumCare Full time

    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...


  • Irvine, California, United States Sunpin Solar Development LLC Full time

    Job OverviewSunpin Solar Development LLC is a leader in the utility-scale solar sector, dedicated to the investment, development, and financing of large-scale solar photovoltaic projects across North America. The Utility-Scale Solar Engineering Specialist plays a pivotal role in driving portfolio and financial expansion by managing the technical, cost...


  • Irvine, California, United States Soliant Full time

    Job SummarySoliant Health is seeking a dedicated and experienced Occupational Therapist to join our team in a clinic setting. As a Pediatric Specialist, you will be responsible for providing high-quality occupational therapy services to patients aged 18 months to 12 years.Key Responsibilities:Deliver pediatric occupational therapy services in a clinic...


  • Irvine, California, United States Optum Full time

    Join Optum, a premier organization in the healthcare sector dedicated to transforming health care with a strong focus on health equity, affordability, quality, and convenience. Our mission is to assist millions of patients in leading healthier lives while enhancing the overall health system for everyone. If you are driven by a desire to positively influence...


  • Irvine, California, United States Insight Global Full time

    Position Overview:Insight Global is seeking a dedicated Utilization Management Coordinator to support one of our prominent healthcare partners. This role is essential in ensuring the smooth processing of authorization requests and enhancing operational efficiency.Key Responsibilities:As a UM Coordinator, you will:Utilize your knowledge and skills to manage...


  • Irvine, California, United States Insight Global Full time

    Position Overview:Insight Global is seeking a dedicated Utilization Management Coordinator to support one of our prominent healthcare partners. This role is essential in ensuring efficient processing of healthcare authorizations and maintaining high standards of service delivery.Key Responsibilities:As a UM Coordinator, you will:Utilize your skills and...


  • Irvine, California, United States Insight Global Full time

    Position Overview:Insight Global is seeking a dedicated Utilization Management Coordinator to support one of our prominent healthcare partners. This role is essential in ensuring the efficient processing of authorization requests and enhancing departmental operations.Key Responsibilities:Utilize your knowledge and skills to manage daily activities that may...


  • Irvine, California, United States SCA Health Full time

    About the RoleWe are seeking a highly skilled Registered Nurse Endoscopy Specialist to join our team at SCA Health. As a key member of our perioperative team, you will be responsible for providing exceptional patient care and ensuring a smooth and safe experience for our patients undergoing endoscopy procedures.Key ResponsibilitiesDevelop and implement...


  • Irvine, California, United States Integrity Construction Management Full time

    Job OverviewThe Substation Construction Specialist will oversee field operations for construction projects, supporting project management across various service areas, focusing on substation projects and reporting to the appropriate authority.Key Responsibilities:Clear experience with substation construction, including project planning, execution, and...


  • Irvine, California, United States SCA Health Full time

    About SCA HealthSCA Health is a dynamic healthcare organization that has grown to 11,000 teammates who care for 1 million patients each year. We support physician specialists holistically in many aspects of patient care, aligning physicians, health plans, and health systems around a common goal: delivering high-quality outcomes and a better experience for...


  • Irvine, California, United States Hoag Full time

    Salary Range: $ $ /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education. The Perioperative Nursing Specialist plays a crucial role in delivering comprehensive patient care within a surgical environment. This position involves direct patient interaction in accordance with the Nurse Practice Act, ensuring...


  • Irvine, California, United States Tailored Management Full time

    Job OverviewExciting opportunity to work with a global leader in designing and constructing electrical systems, providing essential services across the aerospace, defense, transportation, and security sectors.Shift Schedule and Compensation: Standard Business Hours with a competitive pay rate of $39.29/hr on W2 (Weekly Pay) - 40 hours per week.Role...


  • Irvine, California, United States City of Hope Full time

    Pharmaceutical Care SpecialistBecome a vital member of the City of Hope team, where we are dedicated to transforming lives and making significant strides in the battle against cancer, diabetes, and other critical health challenges. Our expanding national network encompasses a main campus in Los Angeles, a series of clinical care sites throughout Southern...


  • Irvine, California, United States Management Business Solutions Full time

    Radiology and Nuclear Medicine Specialist Salary Range: $110,000 to $150,000 + Comprehensive Benefits + Performance Bonus Sign-On Bonus: $10,000 Relocation Support Available As a key member of the healthcare team, the incumbent will report to the Nuclear Medicine Supervisor and will be tasked with executing a comprehensive array of in vivo and in vitro...