Utilization Management Admissions Liaison RN II (Nights)

Job ID 13180 | Location: Los Angeles, 90017 | Full Time Nights

About the role

The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for receiving and reviewing admission requests and higher level of care (HLOC) transfer requests from inpatient facilities within regular timelines. Reviews clinical data in real-time and post-admission to issue determinations based on clinical criteria for medical necessity. Ensures timely, accurate determination and notification of admission and inter-facility transfer requests. Generates approval, modification, and denial communications for inpatient admission requests. Actively monitors for appropriate level of care (inpatient vs. observation) admission in the acute setting.

Works with UM leadership, including the Utilization Management Medical Director, on requests where determination requires extended review. Collaborates with the inpatient care team for facilitation and coordination of patient transfers between acute care facilities. Acts as a department resource for medical service requests, referral management, and processes. Actively participates in the discharge planning process, including providing clinical review and authorization for alternate levels of care, home health, durable medical equipment, and other discharge needs. Provides support to the inpatient review team as necessary to ensure timely processing of concurrent reviews.

Responsibilities

• Review admission and higher level of care (HLOC) transfer requests from inpatient facilities.
• Review clinical data in real-time and post-admission to determine medical necessity based on clinical criteria.
• Ensure timely and accurate determination and notification of admission and inter-facility transfer requests.
• Generate approval, modification, and denial communications for inpatient admission requests.
• Monitor for appropriate level of care (inpatient vs. observation) in the acute setting.
• Collaborate with UM leadership and the Utilization Management Medical Director on complex review requests.
• Facilitate and coordinate patient transfers between acute care facilities with the inpatient care team.
• Serve as a department resource for medical service requests and referral management.
• Participate in discharge planning, including clinical review and authorization for alternate levels of care, home health, durable medical equipment, and other discharge needs.
• Support the inpatient review team to ensure timely processing of concurrent reviews.

Requirements

• Minimum of 7 years of clinical experience in an acute hospital setting.
• Strong understanding of Utilization Management/Case Management practices, including placement (with level of care) criteria (MCG, InterQual), concurrent review, and discharge planning.

Qualifications

• Required: Associate's Degree in Nursing.
• Preferred: Bachelor's Degree in Nursing.
• Preferred: Consistent Critical Care experience (Emergency Department, Intensive Care, Labor & Delivery).
• Preferred: Experience in bed placement decision-making.

About the Hospital

As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.

Why Join Us?

• Opportunity for growth and development.
• Amazing co-workers and a supportive management team.
• Great compensation and benefits.
• Camaraderie and a true sense of mission.

Pay

Pay Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)

Schedule

Full Time Nights