UM Nurse; Inpatient

Position: UM Nurse (Inpatient)
The Inpatient Review Nurse supports patients through the continuum of care by collaborating with physicians, case managers, discharge planners, ancillary service providers, and community resources. This role ensures patients receive the most appropriate, cost-effective, and safe level of care.

Pay: $37-$43/hr (LVN) /$45-$52/hr (RN)

Shift:
Mon-Fri (8am-5pm PST)

Key Responsibilities:

• Conduct inpatient reviews for patients with complex medical and social needs.
• Review inpatient admissions promptly, applying evidence-based guidelines to determine level of care and continued stay.
• Coordinate care with contracted ancillary providers, community agencies, and IPA/MGs as necessary.
• Perform follow-up reviews in ambulatory or lower levels of care settings.
• Communicate effectively with patients, families, physicians, and care teams to support safe, coordinated care.
• Identify members needing complex or chronic case management post-discharge; facilitate warm handoffs to ambulatory care teams.
• Oversee daily activities of CCIP Coordinators.
• Record all communications and care activities in EZ-Cap and/or case management systems.
• Participate in multidisciplinary patient care conferences and rounds.
• Monitor, document, and report clinical criteria in line with UM policies and procedures.
• Track and report utilization patterns, including over utilization and under utilization.
• Refer cases as appropriate to the Quality Management department.
• Enter data for case management reporting.
• Provide regular updates on open cases to the Medical Director, Director of Healthcare Services, and UM Manager.

REQUIREMENTS:

• Required:
  
  California RN or LVN
• 2 years of recent experince as UM Nurse conducting concurrent reviews for inpatient services.
• Ability to work PST Hours and have high speed internet

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

* As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient's residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities.

Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.