Utilization Management Nurse Specialist RN II

5 days ago


Los Angeles, United States L.A. Care Health Plan Full time

Job Category: Clinical

Location: Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 11812

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities.

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary referrals that meet established criteria. Responsibilities include:

Duties
  1. Promote and support team engagements, programs, and activities for a positive workplace environment.
  2. Perform telephonic and/or onsite admission and concurrent review, collaborating with staff, physicians, and providers to develop discharge plans.
  3. Generate communication for all determinations within required timelines.
  4. Facilitate/review requests for higher levels of care or skilled nursing.
  5. Identify and initiate referrals for appropriate members to L.A. Care programs.
  6. Receive and professionally handle incoming calls from providers.
Education Required

Associate's Degree in Nursing

Education Preferred

Bachelor's Degree in Nursing

Experience

Required: At least 5 years of varied clinical experience in an acute hospital setting and at least 2 years of Utilization Management/Case Management experience.

Preferred: Managed Care experience performing UM and CM at a medical group or management services organization.

Skills

Required: Computer literate with expertise in Outlook, Word, Excel, and PowerPoint. Excellent customer service, time management, and communication skills are essential.

Preferred: Knowledge of NCQA requirements for Utilization Management.

Licenses/Certifications Required

Registered Nurse (RN) - Active, current, and unrestricted California License

Physical Requirements

Light

Additional Information

May work on occasional weekends and some holidays depending on business needs.

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.

L.A. Care offers a wide range of benefits including:

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental, and Vision
  • Wellness Program
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