Offer summary

Qualifications:

CA licensed RN with a minimum of 5 years of clinical experience in acute care settings such as med-surg, ICU, or ER., At least 2 years of experience as a hospital-based discharge planner., Strong understanding of Medi-Cal post-acute care benefits and MCG inpatient criteria., Experience in reviewing and interpreting facility contracts related to post-acute levels of care..

Key responsibilities:

Collaborate with CA hospitals and Skilled Nursing Facilities to ensure safe discharges of Health Plan members.

Utilize MCG criteria to assess and facilitate transitions to lower levels of care.

Communicate compassionately with members and providers to support seamless care transitions.

Demonstrate accountability in the discharge process to ensure effective and efficient member transfers.

Job description

Position: Care Review Clinician II
Location: 100% Remote
Payrate: $45.99/hr on W2
Duration: 03+ months temp to hire role
Schedule: Monday thru Friday, M-F 8:30AM- 5:30 PM PST

Job Description:
RN will be working daily with CA hospitals, SNF’s, and other lower level of care entities to discharge CA Health Plan members safely to a lower level of care. Utilization of MCG criteria,

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

Day to Day Responsibilities:
Working with CA hospitals, Skilled Nursing, and other lower level of care settings to discharge Health Plan members safely to a lower level of 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