Inpatient Review Nurse, LVN or RN - AppleCare Medical Group! Buena Park, CA

AppleCare Medical Group was formed in Lynwood, California, in 1996. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors—but the mission has remained the same. Today, AppleCare Medical Group is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.

As a part of our continued growth, we are searching for a new Inpatient Review Nurse to join our team...

The Inpatient Review Nurse is responsible for the facilitation of the inpatient Utilization Management process including in-network, out of network, case management and discharge planning as well as assisting the Director of Inpatient Management with UM/QM functions as necessary. In addition, this role acts as a facility liaison to promote cooperation and efficiency between the IPA and the Hospital.  

KEY RESPONSIBILITIES:  

·         Tracks inpatient admissions and discharges

·         Performs Concurrent Review and Discharge Planning

·         Ensures that patients are receiving appropriate care at contracted facilities and with contracted Providers

·      Attends inpatient review rounds and presents cases to medical director(s), health plans and AppleCare Medical management staff

·      Works collaboratively with AppleCare Hospitalists to develop and implement inpatient processes

·         Identification of patients and referral to specialty clinics such as Comprehensive Care (high-risk) Clinic, Anti-coagulation and/or Diabetic Clinic

·         Performs all other related duties as assigned

JOB REQUIREMENTS:

• Current RN or LVN license in the state of California


• 3 or more years of Inpatient Nursing experience


• Thorough knowledge of common inpatient diagnosis'


• Computer proficiency in MS Office: Outlook, Word, Excel, PowerPoint


• Excellent written and verbal communication skills


• Access to reliable transportation, car insurance and valid CA driver's license

PREFERRED EXPERIENCE:

• RN license


• Possess an understanding of Diagnosis Related Groups (DRG's)


• Managed Care work experience


• Previous Inpatient Utilization Management or Case Management experience


• BSN degree

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Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing