RN Utilization Mgmt, Full-Time Day

Coordinate e-TAR submissions, manage clinical denials, and process insurance authorizations for Medi-Cal and other payers. Review observation patients daily for continued stay or conversion to inpatient appropriateness, ensuring documentation meets medical necessity criteria before discharge. Facilitate interdisciplinary team rounds to support timely care, minimize adverse outcomes, and communicate beneficiary benefits and care structures. Screen patient charts to justify assessments and discharge planning needs while adhering to department policies and the Jean Watson Model of Care. Maintain Compass program training and complete required BLS certification. This role supports the Care Management Department's Quality and Performance Improvement Plan, utilizing bilingual skills (Spanish) and prior authorization experience to optimize health plan reimbursement and care efficiency.