Utilization Management Admissions Liaison RN II (Nights)

Working Nurse; Los Angeles (CA); On-site; USD 89,000 - 142,000; Full time

Job summary

The Utilization Management Admissions Liaison RN II (Nights) at Working Nurse in Los Angeles, CA, reviews admission requests and transfers, determines medical necessity, and coordinates with inpatient teams for timely decisions. This role emphasizes discharge planning and coordination across facilities, ensuring efficient patient care pathways.

Requires an Associate's in Nursing and a Bachelor’s in Nursing, with a minimum of seven years in an acute hospital setting and knowledge of UM/Case

Qualifications

• Minimum of 7 years of clinical experience in an acute hospital setting.
• Understanding of Utilization Management/Case Management practices including placement criteria (MCG, InterQual), concurrent review, and discharge planning.

Responsibilities

• Receive/review admission requests and HLOC transfer requests from inpatient facilities within regular timelines.
• Review clinical data in real-time and post admission to issue determinations of medical necessity.
• Generate approval, modification, and denial communications for inpatient admission requests.
• Assist with discharge planning and coordinate transfers and alternate levels of care as needed.

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Job description

RN Job

Utilization Management Admissions Liaison RN II (Nights)

Shift: Full Time

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

Job ID: 13180

Location: Los Angeles, 90017

Job Description

The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for receiving/reviewing admission requests and higher level of care (HLOC) transfer requests from inpatient facilities within regular timelines. Reviews clinical data in real-time and post admission to issue a determination based on clinical criteria for medical necessity. Assures timely, accurate determination and notification of admission and inter-facility transfer requests. Generates approval, modification, and denial communications for inpatient admission requests. Actively monitors for appropriate level of care (inpatient vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests where determination requires extended review. Collaborates with the inpatient care team for facilitation/coordination of patient transfers between acute care facilities. Acts as a department resource for medical service requests/referral management and processes. Actively participates in the discharge planning process, including providing clinical review and authorization for alternate levels of care, home health, durable medical equipment, and other discharge needs. Provides support to the inpatient review team as necessary to ensure timely processing of concurrent reviews.

Qualifications

Education Required

• Associate's Degree in Nursing

Education

• Bachelor's Degree in Nursing

Experience Required

• Minimum of 7 years of clinical experience in an acute hospital setting. Previous experience to have a strong understanding of Utilization Management/Case Management practices including, but not limited to, placement (with level of care) criteria (MCG, InterQual), concurrent review, and discharge planning.

Preferred

• Consistent Critical Care experience (Emergency Department, Intensive Care, Labor & Delivery) background highly desirable.
• Experience in bed placement decision-making highly desirable.

About The Hospital

As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.

Why Join Us?

Opportunity. Amazing co-workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.