Utilization Management Nurse: Care Coordination & Discharge Planning

North East Medical Services; Burlingame (CA); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Free health, dental & vision insurance

401(k) company contribution

Job summary

North East Medical Services seeks an Utilization Management Nurse to review UM cases, coordinate discharge planning, and support audits and reporting. You will work closely with the UM/QI Manager, MSO UM team, MSO Medical Director, and physician reviewers to ensure timely case processing and high-quality care.

The role requires an active California RN license with BLS. Strong collaboration, documentation, and communication skills are essential for success in this position.

Qualifications

• Active California Registered Nurse license is required.
• Current Basic Life Support (BLS) documentation is required.
• Willingness to engage with diverse teams and communities.

Responsibilities

• Review UM cases and discharge planning activities.
• Coordinate patient care with UM/QI Manager and MSO teams.
• Support audits and required reporting for UM program.
• Assist with transition of care services and post-discharge follow-up.
• Ensure timely reviews and adherence to medical necessity criteria.
• Utilize multiple systems to document case activities and reporting.

Skills

Clinical coordination

Documentation

Communication

Team collaboration

Education

RN license (California)

BLS certification

Job description

North East Medical Services seeks an Utilization Management Nurse to review UM cases, coordinate discharge planning, and support audits and reporting. You will work closely with the UM/QI Manager, MSO UM team, MSO Medical Director, and physician reviewers to ensure timely case processing and high-quality care.

The role requires an active California RN license with BLS. Strong collaboration, documentation, and communication skills are essential for success in this position.