RN Utilization Mgmt, Full-Time Day
On-siteLos Angeles, California, United States
Job Summary
Coordinate care submission from patient admission to discharge, managing e-TAR processes, denials, and insurance authorizations for observation and inpatient stays. Review patient charts daily to justify medical necessity and discharge planning, ensuring completion of records prior to Medi-Cal submission via e-TAR. Collaborate with interdisciplinary teams and finance staff to optimize care workflows, track submitted e-TARS, and facilitate timely referrals to health plans and provider networks. This role supports high-quality care and reimbursement categories within the Care Management Department, adhering to department policies and the Jean Watson Model of Care. Candidates must hold a current California RN license with 3-5 years of case management or utilization experience, including MCG and Interqual knowledge.
Required Qualifications
- Associates Degree in Nursing
- Minimum 3-5 years recent experience in Case Management or Utilization Management or Prior Authorization
- Current California Registered Nurse License
- Experience in MCG and/or Interqual
- Current Basic Life Support (BLS)
Desired Qualifications
- BSN
- Certification in UM or CM
- Bilingual language skills (Spanish)
- Basic computer skills
- A team player that can follow a system and protocol to achieve a common goal
- Highly organized and well developed oral and written communication skills
- Confidence to communicate and outreach to other community health care organizations and personnel
- Demonstrates sound judgment, decision making and problem solving skills
- CCM Certification
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.