Care Review Clinician II (67520-1)
 Professional Management Enterprises | |
 United States, California, Los Angeles | |
 Feb 25, 2025 | |
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Care Review Clinician I(RN)to work daily with CA hospitals, SNF's, and other care entities to discharge CA Health Plan members safely to a reduce level of care. This position isFULLY remote, but ***MUST be a licensed RN in the state of CA. The work schedule will be M-F 8:00am-5:00pm PST. KNOWLEDGE/SKILLS/ABILITIES * Minimum 5 years of clinical experience as an acute care nurse in med-surg/ tele, ICU or ER setting * Minimum of 2 years (can be part of the 5 years above) as a hospital based discharge planner for patient discharges to home, SNF, custodial care, LTAC and ARU and an in-depth understanding of what services are available in each of these settings * Strong understanding of Medi-Cal post-acute care benefits- what is and is not a benefit * Strong understanding of MCG inpatient criteria * Experience with reviewing and interpreting facility contracts relating to post-acute levels of care (ie. SNF contract language) * Must demonstrate a high level of accountability to the process of safely, effectively and efficiently transferring members that no longer meet acute care criteria to the most appropriate lower level of care * Must demonstrate a compassionate communication style with members and providers to create seamless transitions in a member's care 1-2 year Utilization Management experience in a HP setting BH service background and/or MCO experience in UM Required Education Required Education: Nursing Degree Required License Licensure required is a CA State License Registered Nurse - RN license | |