UM Transition of Care (TOC) Nurse- Bakersfield 1.1

Universal Healthcare MSO•Bakersfield, CA

15h•Onsite

About The Position

The Utilization Management Transitions of Care (TOC) Nurse supports the UM department by conducting in-person bedside visits with hospitalized members and helping coordinate timely transitions from inpatient care to outpatient follow-up. The position is based in Bakersfield, California, and requires regular travel to designated hospitals and other assigned locations. The nurse works with hospital case managers, discharge planners, physicians, nursing staff, members, caregivers, primary care providers, and internal UM and Care Coordination teams to identify potential clinical, functional, psychosocial, and logistical barriers to discharge and continuity of care. The TOC Nurse gathers clinical and demographic information, reviews available discharge plans and follow-up needs within the individual's license and scope of practice, communicates concerns to appropriate clinical personnel, and assists with coordinating post-discharge appointments and services. The nurse also supports referrals and handoffs to Care Coordination, assigned quality-measure activities, timely documentation, and follow-up under established workflows and organizational policies. Medical necessity determinations and authorization decisions are handled only by appropriately authorized personnel. The RN or LVN must perform duties within their individual licensure, education, training, and authorized scope of practice. This is a full-time, non-exempt, hourly position. Universal Healthcare MSO's standard operating hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Time. The anticipated alternate schedule for this role is 9:00 a.m. to 6:00 p.m.; schedules may be adjusted based on operational requirements. The initial pay range is $31.00–$38.74 per hour for a California-licensed LVN or $43.35–$54.18 per hour for a California-licensed RN, subject to individualized factors such as knowledge, skills, and experience.

Requirements

Current, active California Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license in good standing.
Graduation from a state-approved nursing program appropriate to the license held.
At least two years of nursing experience in an acute-care hospital, utilization management, case management, discharge planning, care coordination, or a related clinical setting.
Knowledge of medical terminology, clinical documentation, inpatient care processes, and transitions-of-care principles.
Ability to recognize potential barriers to discharge and continuity of care and communicate concerns within the individual's scope of practice.
Strong verbal and written communication, interpersonal, organizational, assessment, observation, documentation, and problem-solving skills appropriate to the individual's license and scope of practice.
Ability to interact effectively and compassionately with members, caregivers, providers, and interdisciplinary healthcare teams, including in sensitive, stressful, and fast-paced hospital environments.
Ability to maintain confidentiality and appropriately handle protected health information.
Proficiency with electronic medical records, healthcare information systems, UM systems, and Microsoft Office applications.
Ability to work independently, manage assignments, prioritize competing responsibilities, and meet established deadlines.
Ability and willingness to travel regularly to designated hospitals and other assigned locations for bedside visits; ability to travel between hospitals and manage a field-based work schedule.
Valid California driver's license, reliable transportation, and automobile insurance meeting applicable legal and organizational requirements.
Ability to comply with hospital access requirements, infection-control practices, personal protective equipment requirements, and workplace safety procedures.
Ability to perform the essential functions of the position, with or without reasonable accommodation.
Must not independently direct treatment, diagnose medical conditions, provide advice, or make medical necessity or authorization decisions beyond the individual's scope or authority; concerns beyond an LVN's scope must be escalated appropriately.

Nice To Haves

Bachelor's degree in Nursing (BSN) for RN candidates; additional education in nursing, healthcare administration, or care coordination is a plus.
Three or more years of experience in utilization management, transitions of care, hospital case management, discharge planning, or care coordination.
Experience working with an IPA, medical group, health plan, managed care organization, or hospital system.
Familiarity with Medicare, Medi-Cal, Dual Eligible Special Needs Plans (D-SNP), and managed care requirements.
Experience coordinating post-discharge appointments, referrals, and follow-up services.
Familiarity with electronic UM platforms, authorization workflows, and clinical documentation systems.
Experience identifying social determinants of health and barriers to access, including transportation, caregiver support, medication access, and community resources.
Bilingual English/Spanish skills based on organizational and member population needs.

Responsibilities

Travel to designated hospitals and conduct in-person bedside visits with assigned hospitalized members.
Coordinate visits with hospital personnel in accordance with facility access, privacy, and infection-control requirements.
Build rapport with members and families or caregivers through professional, compassionate, and culturally appropriate communication; respect member rights, preferences, confidentiality, and the right to decline a visit.
Verify member demographics, contact information, providers, caregiver information, pharmacy, and other pertinent details.
Gather relevant information about hospitalizations, anticipated discharge plans, follow-up needs, and outpatient appointments.
Identify potential barriers to successful transitions, including functional limitations, social needs, caregiver availability, transportation, medication access, and access to follow-up services.
Communicate clinical concerns, member-status changes, discrepancies, risks, and unresolved barriers to appropriate licensed clinical personnel or treating teams.
Collaborate with hospital case managers, discharge planners, nursing staff, social workers, and other interdisciplinary team members.
Gather clinical and discharge-related information to support UM and transitions-of-care workflows; review available discharge instructions, medication information, recommended follow-up, and post-discharge service needs within the individual's scope of practice.
Coordinate with hospital personnel to obtain discharge information and supporting documentation through established processes; monitor anticipated discharge dates and communicate changes to appropriate UM personnel.
Support referrals to care management or other resources, and escalate urgent clinical concerns in accordance with facility procedures and organizational protocols.
Assist members with scheduling, confirming, and rescheduling primary care and specialty appointments after hospitalization; verify appointment details and communicate follow-up plans to members and caregivers.
Identify barriers to attending follow-up appointments, communicate unresolved barriers to appropriate UM or care-management personnel, and assist with post-discharge services and referrals as assigned.
Conduct post-discharge follow-up activities when indicated by established workflows or UM leadership, and document outreach, coordination, barriers, interventions, and outcomes.
Gather and communicate member-specific information to authorized UM personnel; coordinate with UM nurses, physicians, hospital personnel, and other interdisciplinary teams.
Follow established UM policies, procedures, workflows, documentation standards, and escalation protocols; ensure medical necessity and authorization decisions are made only by appropriately authorized personnel.
Serve as a communication link between UM and Care Coordination; identify members who may benefit from Care Coordination, route referrals, share relevant information through approved processes, and follow up on assigned handoffs.
Assist with designated quality-measure activities, including identifying potential care gaps, supporting outreach and recommended follow-up, documenting outcomes, and escalating unresolved barriers.
Accurately and promptly document bedside visits, member interactions, findings, barriers, interventions, referrals, handoffs, and follow-up in designated systems; maintain complete, objective, factual, and professional records.
Protect confidential member information and comply with HIPAA, organizational privacy policies, and applicable requirements.
Maintain effective working relationships with hospital and provider personnel, members, families, caregivers, and IPA personnel; participate in meetings, training, audits, and quality-improvement activities as assigned.
Work independently, manage assignments, prioritize competing responsibilities, and meet established deadlines while maintaining professional boundaries and following organizational and hospital policies.