UM Transition of Care (TOC) Nurse- Bakersfield 1.1

Universal Healthcare MSO LLC•Bakersfield, CA

1d•$31 - $54•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 facilitating coordinated transitions from inpatient care to outpatient follow-up. The role requires regular travel to designated hospitals and collaboration with hospital case managers, discharge planners, physicians, nursing staff, members, caregivers, primary care providers, and internal UM and Care Coordination teams. The nurse gathers clinical and demographic information, reviews available discharge plans and follow-up needs, identifies potential barriers to continuity of care, communicates concerns to appropriate personnel, and assists with coordinating appointments and post-discharge services. Duties must remain within the individual’s licensure, education, training, and authorized scope of practice. Medical necessity determinations and authorization decisions are handled by appropriately authorized personnel. The position serves as a liaison between hospital teams and the IPA’s Utilization Management and Care Coordination functions. It supports referrals and handoffs, designated quality-measure activities, member outreach, follow-up, and documentation of care gaps and outcomes. The nurse follows organizational workflows, policies, documentation standards, privacy requirements, and escalation protocols. This is a full-time, non-exempt, hourly position located onsite in Bakersfield, California. Universal Healthcare MSO’s standard operating hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Time. UM schedules may differ according to operational requirements; the anticipated alternate schedule for this role is 9:00 a.m. to 6:00 p.m. The position is primarily performed in a professional office environment but involves regular travel to hospitals and other assigned locations, including frequent movement through hospital facilities. Schedules may vary with hospital needs, member assignments, and organizational priorities. The projected initial hourly pay range is $31.00–$38.74 for a California-licensed LVN and $43.35–$54.18 for a California-licensed RN. The offered base pay may be adjusted based on individualized factors such as relevant 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.
Ability to interact effectively and compassionately with members, caregivers, providers, and interdisciplinary healthcare teams.
Ability to maintain confidentiality and appropriately handle protected health information.
Proficiency with electronic medical records, healthcare information 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.
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 walk, stand, and sit for extended periods, communicate in busy hospital environments, and interact professionally with people experiencing medical, emotional, or psychosocial stress.
Ability to perform essential functions with or without reasonable accommodation.
Duties must be performed according to the individual’s licensure, education, training, and authorized scope of practice; concerns outside an LVN’s scope must be escalated to an appropriate RN, treating provider, or clinical leader.

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 access barriers, 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 and follow facility access, privacy, and infection-control requirements.
Build rapport with members and their families or caregivers using professional, compassionate, and culturally appropriate communication; respect member rights and the right to decline a visit.
Verify member demographics and pertinent contact, provider, caregiver, pharmacy, and other information.
Gather information about hospitalizations, anticipated discharge plans, follow-up needs, and existing outpatient appointments.
Identify potential clinical, functional, psychosocial, and logistical barriers to successful transitions of care, and communicate concerns to appropriate personnel.
Collaborate with hospital case managers, discharge planners, nursing staff, social workers, physicians, and other interdisciplinary team members.
Gather clinical and discharge-related information and review available discharge instructions, medication information, recommended follow-up, and post-discharge service needs within the nurse’s scope of practice.
Identify gaps or risks in discharge planning, continuity of care, and access to recommended services; obtain discharge documentation through established processes.
Monitor anticipated discharge dates and communicate changes to appropriate UM personnel.
Support referrals to Care Coordination or other appropriate resources, share relevant discharge plans and barriers with authorized staff, and follow up on assigned handoffs.
Assist members with scheduling, confirming, and rescheduling primary care and specialty appointments; verify appointment details and explain follow-up plans to members and caregivers.
Identify barriers to attending appointments and communicate unresolved barriers to appropriate UM or Care Coordination personnel.
Assist with coordination of post-discharge services and referrals, and conduct post-discharge follow-up when indicated by established workflows or UM leadership.
Escalate urgent clinical concerns to appropriate treating or emergency-response personnel and escalate other concerns according to organizational protocols.
Communicate member-specific information to authorized UM personnel and assist in identifying members who may benefit from clinical review, care management, or other services.
Follow UM policies, procedures, workflows, documentation standards, and escalation protocols; do not independently make medical-necessity determinations or authorization decisions unless specifically authorized.
Assist with designated quality-measure activities, including identifying potential care gaps, supporting member outreach and recommended follow-up, coordinating with appropriate teams, and documenting outcomes.
Accurately and promptly document bedside visits, member interactions, information obtained, discharge findings, barriers, interventions, referrals, handoffs, and follow-up in approved systems.
Obtain or assist in obtaining discharge summaries, instructions, and other relevant documentation; 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 and communicate professionally with members, caregivers, hospital personnel, provider offices, and IPA teams.
Participate in department meetings, training, audits, and quality-improvement activities as assigned.
Maintain appropriate professional boundaries and comply with organizational and hospital policies during bedside visits.
Manage assigned visits, documentation, and follow-up independently; prioritize competing responsibilities and meet established deadlines.
Travel between assigned hospitals and other locations while complying with hospital access requirements, infection-control practices, and workplace safety procedures.