Rn Jobs in Orange County

About The Position

Requirements

• Completion of an accredited registered nursing (RN) degree program; an Associate of Science (A.S.) is specified.
• Three years of clinical experience.
• Current, unrestricted Registered Nurse (RN) licensure in the state or states of practice.
• MCG Certification, or ability to obtain it within six months of hire.
• Proficient data entry skills and ability to navigate clinical platforms successfully.
• Working knowledge of Microsoft Outlook, Word, and Excel.
• Effective oral and written communication skills.
• Ability to work independently and within a team environment.
• Attention to detail.
• Proper grammar usage and phone etiquette.
• Time management and prioritization skills.
• Customer-service orientation.
• Decision-making and problem-solving skills.
• Strong organizational skills.
• Change resiliency.

Nice To Haves

• Med/surgical, emergency acute clinical care, or home health experience.
• Utilization Management or Utilization Review experience.
• Medicaid, Medicare, or Commercial experience.

Responsibilities

• Complete prospective, concurrent, and retrospective reviews, including reviews of acute inpatient and post-acute admissions, elective inpatient admissions, outpatient procedures, home care services, and durable medical equipment.
• Identify, document, communicate, and coordinate care, engaging collaborative care partners to facilitate transitions to an appropriate level of care.
• Engage with a medical director when additional clinical expertise is needed.
• Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards.
• Identify and refer quality issues to Quality Improvement.
• Identify and refer appropriate members for Care Management.
• Provide guidance to non-clinical staff.
• Provide guidance and support to LPN clinical staff as appropriate.
• Attend medical advisement and State Hearing meetings as requested.
• Assist the Team Leader with special projects or research as requested.
• Perform other job-related duties as requested.

Benefits

• May qualify for a bonus tied to company and individual performance.
• Substantial and comprehensive total rewards package.