Medical Management Specialist RN (SCAN Temp)

SCAN Health Plan; California; On-site; USD 62,000 - 69,000; Full time

Job summary

SCAN Health Plan in Long Beach, CA is seeking a Medical Management Specialist RN to promote medical necessity, quality, and cost-effectiveness of care for its older adult members.

The role requires 3+ years in medical-surgical nursing and utilization management in managed care, with active CA RN licensure. CPUM/CPUR preferred or obtainable within 2 years. Full-time, on-site position with standard M-F hours.

Qualifications

• Current and active California RN license required.
• CPUM or CPUR certification preferred or willing to attain within 2 years.

Responsibilities

• Ensure necessary inpatient and outpatient care is rendered to SCAN members.
• Issue determinations within required regulatory timeframes.
• Collect relevant information and apply evidence-based criteria and guidelines.
• Escalate requests to Medical Director following established guidelines.
• Manage complex medical cases through assessment, planning, and coordination.
• Prepare and deliver case presentations and participate in interdisciplinary team meetings.
• Assist members requiring urgent and emergent medical and behavioral health services.
• Authorize care and services needed for stabilization.
• Facilitate safe and effective discharges from inpatient settings.
• Maintain documentation and data entry requirements adhering to all policies.

Skills

Nursing expertise

Utilization management

Care coordination

Education

Nursing degree

Job description

About This Role

The Medical Management Specialist RN promotes and supports the quality, medical necessity, and cost-effectiveness of care and services based on regulatory guidelines and medical policy. This role is ideal for experienced RNs looking to make a difference in the care of older adults.

Highlights

• Pay: $45 - $50/hour
• Location: Long Beach, CA
• Schedule: Full-time, M-F 9am-6pm PT

What You'll Do

• Ensure necessary inpatient and outpatient care is rendered to SCAN members.
• Issue determinations within required regulatory timeframes.
• Collect relevant information and apply evidence-based criteria and guidelines.
• Escalate requests to Medical Director following established guidelines.
• Manage complex medical cases through assessment, planning, and coordination.
• Prepare and deliver case presentations and participate in interdisciplinary team meetings.
• Assist members requiring urgent and emergent medical and behavioral health services.
• Authorize care and services needed for stabilization.
• Facilitate safe and effective discharges from inpatient settings.
• Maintain documentation and data entry requirements adhering to all policies.

Requirements

Education:

• Nursing degree required

Experience:

• 3+ years of experience in medical-surgical nursing
• 3+ years of Utilization Management/Prior Authorization experience in a managed care setting

Licenses & Certifications:

• Current and active California RN required
• Certified Professional of Utilization Management (CPUM or CPUR) preferred or willing to attain within 2 years

About SCAN Health Plan

SCAN Health Plan is a nonprofit health organization dedicated to improving care for older adults. Founded in 1977, they serve over 500,000 people across multiple states, focusing on compassion, innovation, and integrity in healthcare delivery.