Registered Nurse - Utilization Management

Job Description

Job DescriptionAbout the Role

Join myPlace Health as a Registered Nurse - Utilization Management in Los Angeles, CA. myPlace Health specializes in providing value-based, comprehensive care and coverage for older adults with significant needs, enabling them to thrive in their homes. In this full-time role, you will play a crucial part in ensuring participants receive appropriate and efficient care through our myPlace PACE model, which provides seamless primary care, integrated health plan coverage, and personalized social engagement.

Key Responsibilities

• Conduct utilization reviews for medical services to ensure alignment with established guidelines and participant care plans.
• Assess the medical necessity of admissions, continued stays, and ancillary services.
• Collaborate with interdisciplinary teams, including physicians, social workers, and other healthcare professionals, to optimize participant outcomes.
• Document all review activities accurately and thoroughly in accordance with regulatory standards and myPlace Health policies.
• Identify trends and opportunities for improvement in care delivery and resource utilization.
• Provide comprehensive reports on utilization management activities and outcomes.
• Participate in ongoing training and professional development to maintain expertise in utilization management.

Required Qualifications & Experience

Required:

• 3 years of experience as a Registered Nurse.

Preferred:

• None specified

Benefits

• Health insurance
• Paid time off (PTO)
• 401(k) match
• Dental insurance
• Paid holidays
• Vision insurance
• 401(k)