Utilization Management Nurse Specialist RN II
5 days ago
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- Promote and support team engagements, programs, and activities for a positive workplace environment.
- Perform telephonic and/or onsite admission and concurrent review, collaborating with staff, physicians, and providers to develop discharge plans.
- Generate communication for all determinations within required timelines.
- Facilitate/review requests for higher levels of care or skilled nursing.
- Identify and initiate referrals for appropriate members to L.A. Care programs.
- Receive and professionally handle incoming calls from providers.
Associate's Degree in Nursing
Education PreferredBachelor's Degree in Nursing
ExperienceRequired: 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.
SkillsRequired: 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 RequiredRegistered Nurse (RN) - Active, current, and unrestricted California License
Physical RequirementsLight
Additional InformationMay 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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