What are the responsibilities and job description for the Care Review Clinician II (67522-1) position at Professional Management Enterprises?
Care Review Clinician I(RN) reviewing high level of care transfers. Assisting the Complex Discharge Unit on Complex Care Members. Work with transferring hospital staff and the higher level of care receiving hospital. This position is FULLY remote but
MUST be a licensed CA RN residing in the state of CA . The work schedule will be M-F 8 : 00am-5 : 00pm PST.
Day to Day Responsibilities :
Reviewing high level of care transfers.
Assisting the Complex Discharge Unit on Complex Care Members.
Work with transferring hospital staff and the higher level of care receiving hospital.
Must Have Skills :
5 years of clinical experience as an ICU or ER nurse
Must demonstrate strong clinical skills in order to decipher the acuity of a member's HLOC transfer needs
Strong understanding of MCG inpatient criteria across a broad spectrum of critical care diagnosis
Must be familiar with IPA's, delegation, and working with providers.
Must be able to quickly understand the health plan's hospital network in order to ensure that PAR hospitals are utilized for HLOC transfers whenever possible
Experience with repatriation of members back into network.
Strong communication skills and ability to interact effectively with hospital nurses, attending physicians, hospital administrative staff, and medical directors responsible for transferring and receiving members
Must demonstrate a high level of accountability to the process of safely, effectively and efficiently transferring members to higher level of care facilities
Required Education / Experience
Minimum 5 years within the last 3 years in the ED preferred. CA Managed Care experience preferred.
Required License
Licensure required is a CA State License Registered Nurse - RN license
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