RN Job

Utilization Management Admissions Liaison RN II

Full Time Regular
Req #8691
Los Angeles, 90017

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 regulator 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. Provides the primary clinical point of contact for inpatient acute care hospitals requesting Inpatient care/post-stabilization admission requests, Higher level of care transfers and other emergent transfers or needs. 

Qualifications
  • Excellent time management and priority-setting skills.
  • Maintains strict member confidentiality and complies with all HIPAA requirements.
  • Strong verbal and written communication skills.    
  • Preferred: Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM.
  • Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM or CM.
  • Licenses/Certifications Required
  • Registered Nurse (RN) - Active, current and unrestricted California LicenseLicenses/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.

View Job

 

Additional Jobs at L.A. Care Health Plan

Posted within the last 49 days (6 jobs)

Delegation Oversight Clinical Auditor RN II

Full Time Regular
Req #8569
Los Angeles, 90017

The Facility Site Review Nurse Specialist RN II conducts face-to-face visits...

View Job

Managed Long Term Services and Supports Nurse Specialist RN II

Full Time Regular
Req #8493
Los Angeles, 90017

The Managed Long Term Services and Supports (MLTSS) Nurse Specialist RN II...

View Job

Quality Management Nurse Specialist RN II (ALD)

Full Time Regular
Req #8161
Los Angeles, 90017

The Quality Management Nurse Specialist RN II is responsible for overseeing the...

View Job

Supervisor, Care Management

Full Time Regular
Req #7551
Los Angeles, 90017

This position is responsible in assisting and developing a successful and...

View Job

Supervisor, Utilization Management RN (ALD)

Full Time Regular
Req #8287
Los Angeles, 90017

The Supervisor of Utilization Management (UM) RN is responsible for executing...

View Job

Care Management Specialist II

Full Time Regular
Req #8662
Los Angeles, 90017

The Care Management Specialist II utilizes clinical skills and training to...

View Job

Hiring Now

Experience the Digital Flip Mag

Flip through the pages of the latest Working Nurse magazine on your device.