RN Discharge Planner - CalAIM

Overview

Responsibilities

• Coordinate clinical reviews, utilization management activities, and application of established care management criteria.
• Review clinical documentation, referrals, and pre-certification requests to ensure compliance with department guidelines and regulatory requirements.
• Collaborate with medical directors, providers, site personnel, and care management teams to support patient care, discharge planning, and continuity of care.
• Monitor utilization data, claims reviews, and referral activity to ensure accuracy, appropriate coding, and effective cost management.
• Provide clinical oversight of reentry care plans and coordinate with managed care plans, community providers, and CalAIM partners to support successful care transitions.

Qualifications

This position is available only to those who reside in the United States.