Job description

**This position is locally remote in San Diego, CA.**

Position Summary

Reviews Medical Group’s inpatients on a concurrent basis for medical necessity. Coordinates discharge plans with the hospital or skilled facility’s case manager for timely discharge. Reviews all skilled nursing admissions for appropriateness of admission and continuing care. Issues Notice of Medicare Non-Coverage for all senior skilled nursing discharges.

Job Duties

Essential Job Functions:

Reviews the Medical Group’s inpatients on a concurrent basis for medical necessity. Consideration is given to appropriateness of the setting, intensity and severity of services being provided and the member’s benefits. Documents the review in the authorization system on a daily basis.

Reviews all transitional care unit and skilled nursing admissions for appropriateness of the admission and ongoing for continuing care criteria being met.

Coordinates discharge plans with hospital or skilled nursing case managers for timely discharge or transfer to lower level of care.

Issues Notice of Medicare Non-Coverage to all transitional care and senior skilled nursing members prior to discharge or at exhaustion of benefits.

Contacts out of network facilities for clinical information for any

Medical Group’s member admitted to the facility. Informs member’s PCP of admission. Coordinates transfer to contracted facility as appropriate.

Discusses the medical necessity of continued stay with the attending physician or the Medical Director when level of care appears to be inappropriate or member does not meet criteria.

Position Qualifications and Requirements

Experience/Specialized Skills:

Prior experience in utilization management or discharge planning in a managed care environment. Proficient with computer, Microsoft windows environment.

Education/Course(s)/Training:

Registered Nurse

Licensure/Certification:

Registered Nurse, active California License. Must have reliable transportation, valid California Driver’s License, and proof of insurance.

Non-clinical, office setting.

View our company website to learn more about the company and career opportunities. You may apply through company website or through Indeed.

www.scpmcs.org

SCPMCS is an Equal Opportunity Employer

Job Type: Part-time

Pay: $42.20 - $51.71 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Application Question(s):

• Are you comfortable with this being a part-time only position?
• Do you currently live in San Diego, CA?
• What are your salary expectations for this position?
• What is your interview availability?

Education:

• Associate (Preferred)

Experience:

• Utilization management: 1 year (Preferred)
• Microsoft Office: 1 year (Preferred)
• Inpatient Case Manager: 3 years (Preferred)

License/Certification:

• California RN license (Required)

Work Location: Remote

johnandkristie.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, johnandkristie.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, johnandkristie.com is the ideal place to find your next job.