RN Care Review Clinician II (70616)

Company: Professional Management Enterprises
Location: Los Angeles
Posted on: May 13, 2025

Job Description:

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
Required

Keywords: Professional Management Enterprises, San Clemente , RN Care Review Clinician II (70616), Healthcare , Los Angeles, California