RN Care Review Clinician II (70616)
 Professional Management Enterprises | |
 United States, California, Los Angeles | |
 May 07, 2025 | |
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Care Review Clinician II(RN)will be working daily with CA hospitals, Skilled Nursing, and other lower level of care settings to discharge Health Plan members safely to a lower level of care. Utilization of MCG criteria is required. This position isFULLY remote, but ***MUST be a licensed RN. The work schedule will be M- F 8:00am to 5:30pm PST. Must Have Skills: * Minimum 5 years of clinical experience as an acute care nurse in med-surg/ tele, ICU or ER setting * Minimum of 2 years (can be part of the 5 years above) as a hospital based discharge planner for patient discharges to home, SNF, custodial care, LTAC and ARU and an in-depth understanding of what services are available in each of these settings * Strong understanding of Medi-Cal post-acute care benefits- what is and is not a benefit * Strong understanding of MCG inpatient criteria * Experience with reviewing and interpreting facility contracts relating to post-acute levels of care (ie. SNF contract language) * Must demonstrate a high level of accountability to the process of safely, effectively and efficiently transferring members that no longer meet acute care criteria to the most appropriate lower level of care * Must demonstrate a compassionate communication style with members and providers to create seamless transitions in a member's care Required Years of Experience: Minimum 5 years of clinical experience as an acute care nurse in med surg/tele, ICU or ER setting. Minimum 3 years discharge experience. Managed care experience. Required Licensure / Education: CA licensed RN, Located in CA | |