Location: Maxim Facility Nursing (Glendale, CA 91203)
The nation's largest publicly funded health plan is seeking Registered Nurses experienced in Utilization Management. The position will be full time, Mon-Fri, on a temp-to-perm basis.
Candidates must have an active, unrestricted CA RN license. Experience in case management/utilization management in a hospice, home health, inpatient, or health plan setting is required. Transplant experience a plus.
Qualified candidates should respond to this posting with a resume attached.
• Perform and coordinate the initial assessments and ongoing reassessments of the patients
• Document patient case information within a database system.
• Perform chart review/audits monthly or as needed.
• Participate in monthly case conferences by providing information pertinent to patients
• Partner with the Program Director in development and review of the patients individualized
coordination of care plan.
• Ensure that the patient's medical needs are addressed; consult with the patients physicians
as needed, coordinating plans of treatment, and advocating for the patient when necessary.
• Promote understanding of the medical factors affecting the targeted population.
• Identify and assist patient in accessing entitlements, resources, information, and referrals
for psychosocial needs.
• Participate in Quality Assurance and Utilization review activities, as directed.
• Empower patients in decision making for care planning.
• Maintain accurate and timely patient information, which readily accessible for review and
meet all requirements; assist in data collection for reporting/funding sources.
• Foster intra-facility and inter-facility working relationships to help accomplish goals. Act as
a liaison between primary care providers, specialist, and/or patient.
• Advocate on behalf of patient regarding accessibility of services.
• Follow State/Country mandated guidelines for the nurse case management programs.
• Participate in outreach activities to the entire target population, as directed.
• Recommend program/service changes to meet gaps in service in the community.
• Other duties as assigned
• Minimum RN with Bachelors in Nursing, Master in Nursing or Public Health preferred.
• Current RN License.
• Prefer at least one year of Case Management experience.
• Current BLS card per contract requirements.
• Current physical exam per state or contract requirements.
• Full command, verbal and written, of the English language.
• Must pass all Maxim screening exams with 80% or greater.
• Must pass criminal background screening.
• Current TB or Chest x-ray.