Senior Utilization Management Nurse Specialist (RN II)

L.A. Care Health Plan; California (MO); On-site; USD 89,000 - 142,000; Full time

Benefits offered by this job

PTO

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Job summary

L.A. Care Health Plan in California is seeking an Utilization Management Nurse Specialist RN II to facilitate referrals, ensure timely determinations, and coordinate discharge planning. You will work with providers, members, and the UM team on pre-service, concurrent, post-service, and retrospective reviews.

Required: Associate's Degree in Nursing, 5+ years RN clinical experience, 2+ years UM/CM in hospital or HMO settings; California RN license. Bachelor's degree preferred.

Qualifications

• RN with at least 5 years of varied clinical experience in an acute hospital setting.
• At least 2 years in Utilization Management/Case Management.
• Bachelor's degree preferred; associate's degree required.
• Strong communication and documentation skills; HIPAA compliant.

Responsibilities

• Promote and support team engagements and a positive workplace.
• Perform admission and concurrent review with discharge planning.
• Generate member and provider communications within policy timelines.
• Facilitate higher level of care reviews and identify network improvements.
• Respond to provider calls with timely, accurate resolutions.
• Document reviews in the system of record.
• Perform other duties as assigned.

Skills

RN clinical skills

Utilization Management

Microsoft Office

HIPAA compliance

Communication skills

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Tools

Outlook

Word

Excel

PowerPoint

Job description

L.A. Care Health Plan in California is seeking an Utilization Management Nurse Specialist RN II to facilitate referrals, ensure timely determinations, and coordinate discharge planning. You will work with providers, members, and the UM team on pre-service, concurrent, post-service, and retrospective reviews.

Required: Associate's Degree in Nursing, 5+ years RN clinical experience, 2+ years UM/CM in hospital or HMO settings; California RN license. Bachelor's degree preferred.