Nurse - Pediatric Utilization Management Specialist
2 weeks ago
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
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Inpatient Utilization Management Nurse
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Irvine, California, United States OptumCare Full timeOptumCare 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...
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RN Position in Pediatric Utilization Management
2 weeks ago
Irvine, California, United States OptumCare Full timeOptumCare 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...
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Irvine, California, United States OptumCare Full timeJob 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...
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Irvine, California, United States OptumCare Full timeJob 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...
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