RN Care Review Clinician II (70616)
Company: Professional Management Enterprises
Location: Los Angeles
Posted on: May 13, 2025
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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, East Los Angeles , RN Care Review Clinician II (70616), Healthcare , Los Angeles, California
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