RN Utilization Mgmt Full-Time Day
Martin Luther King, Jr. Community Hospital
POSITION SUMMARY The RN Utilization Management (RN UM) functions as a support liaisons for a variety of UM functions which may include: the e-TAR process, denials management, and the UM process. Coordinates care submission relating to the process of health care utilization from the point of patient admission to discharge. Assignments may also include management of the clinical denials process in collaboration with finance team. Processes will include arrangement and coordination of documentation for inpatient admissions with continued and extended hospital stays, and discharge review that determine medical necessity. The RN UM will complete and coordinate MCG as needed related to Observation patients including contact with insurance for authorization as needed. The RN UM ensures high quality care and efficiency of utilization available through healthcare resources, facilities, and services substantiating health plan reimbursement categories. This role communicates with the interdisciplinary care team to support the UR process and care management criteria.
ESSENTIAL DUTIES AND RESPONSIBILITIES RN Utilization Management staff may work as assigned in one of the following assignments: ETARS management and/or denials management as well as routine UM functions (insurance authorizations, clinical reviews, and liaison) :
A. Education
B. Qualifications/Experience
C. Special Skills/Knowledge
ESSENTIAL DUTIES AND RESPONSIBILITIES RN Utilization Management staff may work as assigned in one of the following assignments: ETARS management and/or denials management as well as routine UM functions (insurance authorizations, clinical reviews, and liaison) :
- Daily coordination of support documents pertaining to the DNFB List of Medi-Cal patients.
- Ensures completion of patient records and attachments prior to submitting them to Medi-Cal via e-TAR.
- Assist with tracking submitted e-TARS to ensure deferrals and denials are followed-up within a timely fashion.
- Reports e-TAR support progress and delays to Manager or Director of care management.
- Participates in interdisciplinary team and department of revenue meetings to discuss e-TAR work flow, documentation necessity (attachments), process improvement, and submission timeliness.
- Identifies and reviews observation patients daily; performs concurrent MCG/electronic review for continued stay or conversion to inpatient appropriateness reviews as needed.
- Contacts insurance for pre-authorization prior to conversion; collaborates with CM RN to obtain order for admission if appropriate. Responsible for documentation of authorization information in Cerner
- Coordinates with UM Care Coordinator to transfer clinical information to payer as needed.
- Collaborates with interdisciplinary team, participants in team rounds to: (I) facilitate timely care, (2) assures quality of care throughout the hospital stay, and (3) minimizes adverse outcomes.
- Assists with the initiation of appropriate referrals to the internal interdisciplinary team and outside provider networks (health plans, IPAs, and FQHCs) as indicated.
- Communicates with admitting or PFS regarding the needs of the patient, payer, and provider documentation.
- Patient needs are supported within the limitations of the existing individual beneficiary care structure.
- Communicates relevant elements of the health plan benefits.
- Documents and reviews all team member, physician, and patient/family communications and concerns pertaining to coordination of care and services.
- Screens every patient chart to justify identified needs for assessments, documentation of medical necessity, and/or discharge planning needs if assigned.
- Adheres to the Care Management Department policies and procedures.
- Participates in the Quality and Performance Improvement Plan for the Care Management Department.
- Considers the patient population served, age-specific criteria and the Jean Watson Model of Care in all patient/family care and interaction.
- Collaborates with on-site care management team to support best practice guidelines.
- Attends unit/department staff meetings as well as other meetings as assigned.
- Maintain and complete Compass program training as assigned.
- Other duties may be assigned such as denials management and appeals in lieu of other UM duties.
A. Education
- Associates Degree in Nursing required. BSN preferred.
B. Qualifications/Experience
- Minimum 3-5 years recent experience in Case Management or Utilization Management or Prior Authorization
- Current California Registered Nurse License. Certification in UM or CM is highly preferred
- Experience in MCG and/or Interqual required A team player that can follow a system and protocol to achieve a common goal
- 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
C. Special Skills/Knowledge
- Bilingual language skills preferred (Spanish) Basic computer skills
- Current Basic Life Support (BLS)
- CCM Certification preferred
Vacancy posted 17 hours ago
Similar jobs that could be interesting for youBased on the RN Utilization Mgmt Full-Time Day in Huntington Park, CA vacancy
$56 per hour
...Position Summary The Utilization Review/Management Nurse is accountable for planning, directing, and overseeing aspects of daily Utilization... ...and provided to the patient's payer as required. Ensures timely escalation of unresolved care coordination issues to the...Full timeLocal areaImmediate startNOR Healthcare Systems
Bellflower, CA5 days ago$45.16 - $66.4 per hour
...New Grad RN II-ER/FT/Days Job Category: Registered Nurse Requisition Number: NEWGR003364 Full-Time On-site Hourly Range: $45.16 to $66.40 USD Community Hospital of Huntington... ...with patients and family members. Utilizes white boards for patient communication....Full timeHourly payRelocation packageShift workWeekend workCommunity hospital of huntington park
Huntington Park, CA17 hours ago$2,065 - $2,160 per week
...Registered Nurse (RN) | Utilization Review Location: Los Angeles, CA Agency: GQR Healthcare... ...$2,160 per week Shift Information: Days Contract Duration: 13 Weeks... ...every step of the way to sure you start on time and have an exceptional experience ~...Full timeHourly payWeekly payContract workImmediate startShift workTravelNurseSource
Los Angeles, CA11 days ago$2,065 - $2,160 per week
...Registered Nurse (RN) | Utilization Review Location: Los Angeles, CA Agency: GQR Healthcare... ...$2,160 per week Shift Information: Days Contract Duration: 13 Weeks... ...every step of the way to sure you start on time and have an exceptional experience ~...Full timeHourly payWeekly payContract workImmediate startShift workGQR Healthcare
Los Angeles, CA11 days ago$112.28k - $165.07k
...Case Management Supervisor - FT/Days Job Category: Registered... ...Requisition Number: CASEM003156 Full-Time On-site Salary Range: $112,278... ...everyone as their customer; utilizes scripting and other tools to... ...Certifications Required RN Registered Nurse AHA ACLS Adv...Full timeCommunity hospital of huntington park
Huntington Park, CA3 days ago$54.94 per hour
...Registered Nurse (RN), Med/Surg Tele, Full Time, Days Responsible for independently utilizing the nursing process to safely, therapeutically and efficiently care for a group of patients based on policies and procedures. Delivers individualized quality patient care...Full timeWork at officePIH Health
Los Angeles, CA2 days ago- ...NICU RN - Days (Per Diem) Concentric is currently seeking candidates in Registered Nurse profession with focus in Registered Nurse... ...the staffing industry. Minimum Requirements: ~1 year full time Registered Nurse (Neonatal) experience within the last 2 years...Full timeDaily paidContract workTemporary work
Concentric Healthcare
Lynwood, CA1 day ago $50 - $74.98 per hour
...Title: Registered Nurse (RN) Location: Miler Children's Hospital - Long Beach... ...: Transport Team Status: Full-time Shift: Days (12-Hr AWS) Pay Range*: $50/hr-$74.... ...experience, according to established standards utilizing the nursing process, within the scope...Full timeShift workMemorialCare Health System
Long Beach, CA2 days ago- ...RN Post Partum - Per Diem (Days) Concentric is currently seeking candidates in Registered Nurse profession with focus in Registered Nurse (Post... ...staffing industry. Minimum Requirements: ~1 year full time Registered Nurse (Post Partum) experience within the last...Full timeDaily paidContract workTemporary work
Concentric Healthcare
Lynwood, CA1 day ago - ...initial assessment in a timely manner and the ongoing reassessments... ...in the medical record. Utilizes a case management... ...of an accredited RN Training Program. Minimum... ...) required (within 30 days of hire) Los Angeles County... ...: 12 Weekly Hours: 36 Type: Full-Time FTE: 0.9...Full timeHourly payWork experience placementLocal areaShift work
Hollywood Presbyterian Medical Center
Los Angeles, CA1 day ago - Responsible for independently utilizing the nursing process to safely, therapeutically and efficiently... ...Required Experience Current California RN License BLS from American Heart... ...Wilshire Boulevard Salary: 54.94-82.64 Shift: Days Zip Code: 90017 #J-18808-Ljbffr PIH...Full timeShift work
- ...of necessary data in a timely manner; performs ongoing... ...population. Assesses patient utilizing rehabilitation nursing... ...~ Graduate of an RN Training Program.... ...Card (required within 30 days of hire) Assault Response... ...days of hire) Status: Full Time Shift: Days Hours:...Full timeWork experience placementLocal areaShift work
Hollywood Presbyterian Medical Center
Los Angeles, CA1 day ago - ...initial assessment in a timely manner and the ongoing reassessments... ...the medical record. Utilizing a case management... ...: Graduate of a RN Training Program Preferred... ...required (within 30 days of hire). Assault Response... ...- 7:15pm Shift Hours: 12 Type: Full Time FTE: 0.9...Full timeWork experience placementShift work
IntelyCare
Los Angeles, CA11 days ago - ...wellbeing, safety, or dignity. Ability to utilize good clinical judgment to deal tactfully... ...in a professional, courteous and timely manner. This includes answering all phone... ...training/orientation but not to exceed 30 days from hire/transfer. C. Special Skills...Full timeWork at officeFlexible hours
Martin Luther King, Jr. Community Hospital
Huntington Park, CA17 hours ago $50 - $74.98 per hour
...Description Title: Registered Nurse (RN) Location: Miler Children's... ...Department: Transport Team Status: Full-time Shift: Days (12-Hr AWS) Pay Range*: $50/hr-$74... ..., according to established standards utilizing the nursing process, within the scope...Full timeShift workMemorialCare Health System
Long Beach, CA1 day ago$53.58 - $72.11 per hour
...Registered Nurse (RN) California Rehabilitation Institute Century... ...- Los Angeles, CA RN Interview Day Wed 4/12 from 10am - 2pm Full Time - Day Shift 7:00am - 7:30pm Pay... ...accountable for direct patient care by utilizing the nursing process of assessing, planning...Full timeHourly payTemporary workRelocationRelocation packageFlexible hoursDay shiftPhenom People
Los Angeles, CA1 day ago$59.17 - $79.13 per hour
...Wound Care - Registered Nurse - Full Time (8hr shifts) Rate: $59.17 -... ...and credentials and utilizes the database to evaluate and plan... ...Qualifications Valid State RN License required Previous hospital... ...before an employee's first day of work. Additional Data...Full timeHourly payRelocation packageShift workSelect Medical
Los Angeles, CA3 days ago$88.85k
...Utilization Management Claims Review Nurse RN II Job Category: Clinical Department: Utilization Management... ...Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 13077 Salary... ...prioritize tasking, and streamline day-to-day operations. Familiarity with...Full timeL.A. Care Health Plan
Los Angeles, CA2 days ago- ...initial assessment in a timely manner and ongoing reassessments... ...in the medical record. Utilizes a case management... ...Graduate of an accredited RN Training Program.... ...ARC) required (within 30 days of hire) Los Angeles County... ...Weekly Hours: 36 Type: Full-Time FTE: 0.9 #J-18808-...Full timeHourly payWork experience placementLocal areaShift work
$54.2 - $74.34 per hour
RN - Psychiatric Acute (Part-time, Day Shift) Job Description Centered in the heart of Boyle Heights, Adventist... ...coordinates care with other disciplines while utilizing critical thinking, professional and... ...05/27/2026, 07:19 PM Job Schedule Full time Assignment Category Part-time...Full timePart timeWork experience placementWork at officeLocal areaShift workDay shift- ...Improvement Registered Nurse (QI RN) in Cardiology Job... ...Cedars-Sinai, the work you do every day directly affects others' lives.... ...programs to diagnose and treat the full spectrum of heart and vascular... ...Internal Data Management: Utilize internal databases for generating...Full time
$28 - $32 per hour
...Pay Range: $28-32/HR* We have days and NOC shifts available for patients... ...-Paid Life Insurance ~Paid Time Off Available ~Flexible scheduling- full-time, part-time, or PRN. Days, nights... ...Practice Act. • Provide care utilizing infection control measures that protect...Full timeWeekly payDaily paidPart timeFor contractorsReliefLocal areaMonday to FridayFlexible hoursShift workNight shiftWeekend workDay shiftAveanna Healthcare LLC
Lynwood, CA8 days ago$44 - $95 per hour
...the interdisciplinary team, the Registered Nurse utilizes the nursing process to provide therapeutic care to patients. The RN is accountable for coordinating patient care... ...card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration...Full timeHourly payWork at officeImmediate startDay shiftAfternoon shift$47.31 - $100 per hour
...interdisciplinary team, the Registered Nurse utilizes the nursing process to provide... .../liliOrganization Manages time effectively. Able to organize... ...hospital experience as RN./liliReq Must have excellent communication... ...one must be obtained within 30 days of hire and maintained by...Full timeHourly payContract workReliefShift workEarly shift- ...professional Registered Nurse (RN) responsible for excellence in... .... This position requires the full understanding and active participation... ...as a problem solving model; utilizing their knowledge and experience... ...(CPI) Blue Card within 90 Days of hire or requirement...Full timeHourly payShift work
MLK Community Healthcare
Los Angeles, CA1 day ago $51.3 - $81.85 per hour
RN Cardiovascular Services Full Time Days - $10k Sign-On Bonus! Full Time 80 Hrs Los Angeles, CA, US 30+ days ago Requisition ID: 2424 Salary Range: $... ...responding to facility emergencies such as fire, disruption in utilities and hazardous materials spills. Demonstrates knowledge...Full timeHourly payTemporary workWork experience placementRelocation packageShift work$44 - $95 per hour
...interdisciplinary team, the Registered Nurse utilizes the nursing process to provide... ...employee. Organization Manages time effectively. Able to organize... ...hospital experience as RN. Excellent communication skills... ...to obtain ACLS within 180 days or by the end of orientation, whichever...Full timeHourly payContract workReliefShift workEarly shift$44 - $95 per hour
...interdisciplinary team, the Registered Nurse utilizes the nursing process to provide... .... ORGANIZATION: Manages time effectively. Able to organize... ...United States as a licensed RN Req Must have excellent... ...one must be obtained within 30 days of hire and maintained by renewal...Full timeHourly payContract workWork experience placementLocal areaShift work$46.08 - $71.53 per hour
...Description Providence is calling for Revenue Cycle Auditor RN - Full time, Day, Remote The Revenue Cycle Auditor is responsible for... ...in an acute care setting. ~3 years experience actively utilizing EPIC or MEDITECH and data reporting functions. ~3 years experience...Full timeMinimum wageLocal areaRemote workShift workProvidence Health & Service
Los Angeles, CA4 days ago$47.2 - $63.45 per hour
...Francis is recognized for its full range of diagnostic and treatment... ...Social Worker. However, RN Case Manager preferred. 3. Five... ...includes, but is not limited to, paid time off, a 401K retirement plan,... ...Status Full Time Shift Days Equal Employment Opportunity...Full timePart timeWork experience placementLocal areaShift workSt. Francis Medical Center
Lynwood, CA3 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to RN Utilization Mgmt Full-Time Day. Be the first to apply!
Related searches
- registered nurse night shift Huntington Park, CA
- dermatology rn Huntington Park, CA
- agency rn Huntington Park, CA
- full-time registered nurse rn Huntington Park, CA
- registered nurse pharmacy Huntington Park, CA
- home care rn Huntington Park, CA
- outpatient registered nurse - rn Huntington Park, CA
- nurse rn Huntington Park, CA
- rn transport Huntington Park, CA
- registered nurse healthcare Huntington Park, CA