RN Position in Pediatric Utilization Management

2 weeks ago

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 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 healthcare facility and the Independent Practice Association (IPA), fostering collaboration and operational efficiency.

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

Key Responsibilities:
  • Conducts concurrent reviews to ensure appropriate patient care
  • Identifies and documents the necessary level of care accurately
  • Coordinates and documents comprehensive discharge planning
  • Manages in-network services for patients discharged out of network
  • Ensures effective utilization of specialists, providers, and facilities based on regional needs
  • Participates in daily inpatient review rounds, presenting cases to medical directors and case managers
  • Facilitates transfers from out-of-network to in-network facilities
  • Collaborates with internal teams and hospital staff to streamline processes:
    • Initiates agreements for out-of-network services promptly
    • Provides insights for potential contractual agreements
    • Identifies and communicates high-risk cases
    • Monitors utilization of contracted facilities and reports on out-of-network usage
  • Develops and nurtures relationships with hospital staff for both network and out-of-network services
  • Works closely with hospitalists to enhance inpatient processes, including:
    • Identifying patients for specialty clinic referrals
    • Ensuring timely communication between primary care providers and hospitalists
    • Engaging in direct case management activities as needed
    • Identifying patients for care coordination
    • Facilitating referrals for specific health programs
    • Coordinating high-risk patients for case management
  • Engages in various meetings and committees related to quality improvement and care coordination
  • Participates in projects related to inpatient utilization management and quality improvement, ensuring timely completion
At OptumCare, you will be recognized for your contributions in a supportive environment that encourages professional growth and development.

  • Inpatient Utilization Management Nurse

    1 week ago

    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...

  • Physician / Pediatrics / California / Locum or Permanent / RN, Utilization Management, Pediatrics - I

    5 days ago

    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...

  • Pediatric RN for Utilization Review

    1 week ago

    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...

  • Utilization Management Registered Nurse

    2 weeks ago

    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...

  • 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...

  • Pediatrician / Utilization Management RN / California / Locum or Permanent

    5 days ago

    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...

  • Pediatric Utilization Management Registered Nurse

    2 weeks ago

    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...

  • Utilization Management Coordinator

    2 weeks ago

    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...

  • Utilization Management Coordinator

    2 weeks ago

    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...

  • Utilization Management Coordinator

    2 weeks ago

    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...

  • Clinical Faculty Position in Pediatric Pharmacy Practice

    3 days ago

    Irvine, California, United States University Of California Irvine Full time

    Job SummaryThe University of California, Irvine is seeking a highly qualified individual for a faculty position in Pediatric Pharmacy Practice within the Department of Clinical Pharmacy Practice. This is an exciting opportunity to join a renowned institution and contribute to the advancement of pediatric pharmacy education and research.Key...

  • Utilization Management Licensed Vocational Nurse

    2 weeks ago

    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...

  • Construction Project Manager

    1 week ago

    Irvine, California, United States TE Roberts Inc Full time

    Job SummaryT.E. Roberts, Inc. is a leading pipeline construction company in Southern California, seeking a seasoned Project Manager to lead our wet utilities projects and drive our growth.Key ResponsibilitiesDevelop and implement comprehensive project plans, ensuring alignment with client expectations and company standards.Lead and motivate field staff,...

  • Travel Nurse RN Case Management Position

    3 days ago

    Irvine, California, United States Summit Medical Staffing Nursing Full time

    Job Title: Travel Nurse RN Case Management PositionJob Summary:Summit Medical Staffing Nursing is seeking a skilled Travel Nurse RN Case Manager to join our team. As a Travel Nurse RN Case Manager, you will be responsible for providing high-quality patient care and managing case management services for our clients.Responsibilities:Provide patient care and...

  • Inpatient Pediatrics Clinician Educator

    2 weeks ago

    Irvine, California, United States Keck School of Medicine Full time

    Position Overview: The Keck School of Medicine's Department of Pediatrics is seeking a dedicated professional for a full-time faculty role as an Assistant Professor of Clinical Pediatrics within the Division of Inpatient and Critical Care Pediatrics.Key Responsibilities:Provide comprehensive in-house care as part of a 24/7 service.Engage in teaching and...

  • Pediatric Speech Therapist

    4 days ago

    Irvine, California, United States Soliant Full time

    Job SummarySoliant Health is seeking a dedicated Speech-Language Pathologist (SLP) to join our pediatric clinic team. This position offers flexibility with both full-time and part-time options, with working hours from 10 AM to 6 PM. The caseload consists of children aged 3-13 years.Key ResponsibilitiesConduct Comprehensive Assessments: Conduct thorough...

  • Certified Pediatric Medical Assistant

    1 week ago

    Irvine, California, United States ABC CHILDREN'S CLINIC INC. Full time

    Job OverviewWe are seeking a compassionate and skilled Certified Pediatric Medical Assistant with expertise in administering injections and managing both front and back office operations. The ideal candidate will demonstrate a strong understanding of professional conduct, ensuring effective communication with both patients and staff.ResponsibilitiesAssist in...

  • Cost Management Lead

    1 week ago

    Irvine, California, United States APSI Construction Management Full time

    Position Overview: APSI Construction Management is seeking a dedicated and experienced professional for the role of Cost Control III. This position requires on-site presence and a willingness to commute. Project Overview: The current initiative involves a significant multi-year program aimed at replacing a medical facility that does not meet seismic safety...

  • Case Management Travel RN

    5 days ago

    Irvine, California, United States TravelNurseSource Full time

    Job SummaryWe are seeking a skilled Case Management Registered Nurse (RN) to join our team at TravelNurseSource. As a Case Management Travel RN, you will have the opportunity to make a positive impact on patient care and lead the charge forward in your healthcare career.About the PositionThis is a 13-week assignment with 8hr Days, 40hrs per week. The ideal...

  • Travel Nurse RN Case Manager

    2 days ago

    Irvine, California, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Manager for a travel nursing job.Job Summary:We are seeking a skilled Case Manager-Registered Nurse for an assignment with our esteemed client in California.Key Responsibilities:Provide exceptional case management services to patients and families.Collaborate with healthcare teams to develop...