Integrated Transitional Care Nurse, RN

Integrated Transitional Care Nurse, RN

Position Overview

A California health plan is seeking a Temporary Integrated Transitional Care Nurse, RN to support high-risk member populations through coordinated, high-quality transitional care services. This role partners closely with hospitals, Independent Physician Associations (IPAs), and interdisciplinary teams to ensure smooth transitions across care settings and to reduce readmissions. The RN will utilize evidence-based clinical criteria to perform utilization review, discharge planning, and post-discharge follow-up.

Location

Hybrid, on-site Tues-Thurs

Employment Type

Temporary

Key Responsibilities

Utilization Review & Clinical Assessment

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  Conduct discharge risk assessments for high-risk/high-acuity members
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  Perform concurrent and retrospective utilization reviews for medical necessity, level of care, and appropriateness of services
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  Complete initial admission reviews within 24 hours to ensure criteria are met
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  Utilize evidence-based clinical criteria in all clinical decision-making
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  Identify and report quality of care concerns and outliers
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  Refer cases requiring escalation to the Medical Director within established timelines
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  Ensure compliance with denial processes and regulatory documentation requirements

Care Coordination & Transitions

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  Collaborate with interdisciplinary teams (LCSW, Pharmacist, CHW, Coordinators, etc.) to coordinate care transitions
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  Facilitate movement to appropriate levels of care and assist with transfer coordination
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  Serve as a liaison between the health plan, hospitals, providers, and community resources

Discharge Planning & Post-Discharge Support

Support discharge planning and post-discharge coordination, including:

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  DME verification
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  PCP follow-up scheduling
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  Medication reconciliation
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  Transportation arrangements
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  Conduct post-discharge outreach to confirm adherence to care plans
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  Refer members to Care Management, Behavioral Health, Housing, and other support services as needed

Required Qualifications

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  Active, unrestricted California RN license
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  Minimum 2+ years of experience in Utilization Management or Case Management in:
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    Acute Care, OR
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    Skilled Nursing Facility (SNF) settings
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  Strong experience with:
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    Concurrent review
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    Utilization management processes
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  High School Diploma or GED required (Bachelor's degree in Nursing preferred)

Additional Requirements

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  Valid California Driver's License and auto insurance
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  Clean driving record (no more than 3 points; must meet IEHP standards)
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  Ability to travel to multiple IEHP and provider locations
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  Successful completion of:
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    Background check
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    Drug screen
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    Physical examination
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    Professional license verification
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    Motor Vehicle Record (MVR) review

Key Skills & Competencies

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  Knowledge of evidence-based clinical criteria and California Children's Services (CCS)
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  Strong analytical and critical thinking skills
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  Excellent communication, organizational, and interpersonal skills
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  Ability to work independently as a self-starter and collaboratively within a team environment