RN Care Review Clinician II (70616)

Professional Management Enterprises; Los Angeles (CA); Remote; USD 80,000 - 100,000; Full time

Job summary

An established industry player is seeking a Care Review Clinician II (RN) to join their team. This fully remote role requires a licensed RN with extensive clinical experience, particularly in acute care settings. You will be responsible for coordinating patient discharges to various care levels, ensuring safe transitions while utilizing MCG criteria. The ideal candidate will have a compassionate approach and strong communication skills, making a significant impact on patient care. If you're passionate about improving healthcare outcomes and have a knack for discharge planning, this opportunity is perfect for you.

Qualifications

• 5+ years of clinical experience in med-surg/tele, ICU, or ER settings.
• 3+ years of discharge planning experience in a hospital setting.

Responsibilities

• Work with hospitals and nursing facilities to discharge Health Plan members safely.
• Utilize MCG criteria for appropriate care level transitions.

Skills

Clinical experience as an acute care nurse

Discharge planning

Understanding of Medi-Cal post-acute care benefits

MCG inpatient criteria knowledge

Reviewing and interpreting facility contracts

Compassionate communication skills

Education

CA licensed RN

Job description

Care Review Clinician II (RN)

This position involves working daily with CA hospitals, Skilled Nursing facilities, and other lower level of care settings to safely discharge Health Plan members to appropriate care levels. Utilization of MCG criteria is required. This role is FULLY remote, but ***MUST be a licensed RN***. The work schedule is Monday to Friday, 8:00 am to 5:30 pm PST.

Must Have Skills:

1. Minimum 5 years of clinical experience as an acute care nurse in med-surg/tele, ICU, or ER settings.
2. At least 2 years (which can be included in the 5 years above) as a hospital-based discharge planner for patient discharges to home, SNF, custodial care, LTAC, and ARU, with an in-depth understanding of services available in each setting.
3. Strong understanding of Medi-Cal post-acute care benefits—what is and is not covered.
4. Strong understanding of MCG inpatient criteria.
5. Experience reviewing and interpreting facility contracts related to post-acute care levels (e.g., SNF contract language).
6. High level of accountability in safely, effectively, and efficiently transferring members who no longer meet acute care criteria to the most appropriate lower level of care.
7. Compassionate communication skills with members and providers to facilitate seamless care transitions.

Required Years of Experience:

Minimum 5 years of clinical experience as an acute care nurse in med-surg/tele, ICU, or ER settings. Minimum 3 years of discharge planning experience. Managed care experience preferred.

Required Licensure / Education:

CA licensed RN, located in CA.