RN Utilization Mgmt, Full-Time Day
On-siteLakewood, California, United States
Job Summary
Coordinate care submission from admission to discharge, manage clinical denials, and process e-TAR submissions for Medi-Cal patients. Perform concurrent MCG reviews for observation patients, contact insurance for pre-authorizations, and document authorization details in Cerner. Collaborate with the interdisciplinary team to facilitate timely care, ensure medical necessity, and minimize adverse outcomes. Screen patient charts to justify assessments and discharge planning needs while adhering to department policies and the Jean Watson Model of Care. This full-time day role supports the Care Management Department, requiring a California RN with 3-5 years of case management experience, MCG/Interqual proficiency, and bilingual skills.
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)
- 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
Desired Qualifications
- BSN
- Certification in UM or CM
- Bilingual language skills (Spanish)
- Basic computer skills
- CCM Certification
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.