Utilization Management Admissions Liaison RN II

Job Description

The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for receiving/reviewing admission requests and higher level of care (HLOC) transfer requests from inpatient facilities within regular timelines. Reviews clinical data in real-time and post admission to issue a determination based on clinical criteria for medical necessity.

Assures timely, accurate determination and notification of admission and inter-facility transfer requests. Generates approval, modification, and denial communications for inpatient admission requests. Actively monitors for appropriate level of care (inpatient vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests where determination requires extended review.

Collaborates with the inpatient care team for facilitation/coordination of patient transfers between acute care facilities. Acts as a department resource for medical service requests/referral management and processes.

Actively participates in the discharge planning process, including providing clinical review and authorization for alternate levels of care, home health, durable medical equipment, and other discharge needs. Provides support to the inpatient review team as necessary to ensure timely processing of concurrent reviews.

Qualifications

Education Required

• Associate's Degree in Nursing

Education Preferred

• Bachelor's Degree in Nursing

Experience Required:

• Minimum of 7 years of clinical experience in an acute hospital setting.
• Previous experience to have a strong understanding of Utilization Management/Case Management practices including, but not limited to, placement (with level of care) criteria (MCG, InterQual), concurrent review, and discharge planning.

Preferred:

• Consistent Critical Care experience (Emergency Department, Intensive Care, Labor & Delivery) background highly desirable.
• Experience in bed placement decision-making highly desirable.

Licenses/Certifications Required

• Registered Nurse (RN) - Active, current and unrestricted California License

Licenses/Certifications Preferred

• Certified Case Manager (CCM)
• American Case Management Association (ACM)

About the Hospital

As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.

Why Join Us?
Opportunity. Amazing co-workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.