Registered Nurse - Utilization Management
myPlace Health
Job Description
Job Description
About the Role
Join myPlace Health as a Registered Nurse - Utilization Management in Los Angeles, CA. myPlace Health specializes in providing value-based, comprehensive care and coverage for older adults with significant needs, enabling them to thrive in their homes. In this full-time role, you will play a crucial part in ensuring participants receive appropriate and efficient care through our myPlace PACE model, which provides seamless primary care, integrated health plan coverage, and personalized social engagement.
Key Responsibilities- Conduct utilization reviews for medical services to ensure alignment with established guidelines and participant care plans.
- Assess the medical necessity of admissions, continued stays, and ancillary services.
- Collaborate with interdisciplinary teams, including physicians, social workers, and other healthcare professionals, to optimize participant outcomes.
- Document all review activities accurately and thoroughly in accordance with regulatory standards and myPlace Health policies.
- Identify trends and opportunities for improvement in care delivery and resource utilization.
- Provide comprehensive reports on utilization management activities and outcomes.
- Participate in ongoing training and professional development to maintain expertise in utilization management.
Required:
- 3 years of experience as a Registered Nurse.
Preferred:
- None specified
- Health insurance
- Paid time off (PTO)
- 401(k) match
- Dental insurance
- Paid holidays
- Vision insurance
- 401(k)
Vacancy posted 25 days ago
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