Registered Nurse (RN) - Primary Care/Care Management

The Utilization Management (UM) Nurse supports appropriate level‑of‑care determination, patient flow, and revenue cycle integrity across inpatient, partial hospitalization, and intensive outpatient programs. The UM Nurse functions in two utilization management roles for coverage purposes utilization review/payor authorization and patient placement-ensuring continuity of operations, timely access to care, and optimal bed utilization.
Communicates clinical information to support medical necessity determinations and continued‑stay approvals.
Serves as a liaison between payors and the interdisciplinary treatment team regarding authorization and level‑of‑care requirements.
Collaborates with financial counseling and revenue cycle teams to support accurate reimbursement.
Performs patient placement responsibilities as part of utilization management coverage.
Assesses clinical acuity, level‑of‑care needs, and bed availability to support timely admissions and transfers.
Completes required documentation accurately and timely in the electronic health record.
Participates in quality improvement initiatives related to utilization management and patient flow.
5 years of psychiatric nursing care experience required.

• Current valid CA RN license, required
• Prior case management experience, highly desired
• Proficient in Microsoft Office

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