Pediatric Unit Program C/M Nurse Coordinator

These Registered Nurse (RN) positions will be part of our expanding Pediatric Unit Program (PUP) team. This position reports to the Pediatric Unit Manager.

Responsibilities of the Case Management Nurse Coordinator include but are not limited to:
1. processing authorization and referral requests in a timely and efficient manner;
2. applying appropriate clinical guidelines for decision-making;
3. coordinating specialist care and out-of-area services;
4. developing member-centered care plans;
5. communicating clearly and effectively with members, their families and providers;
6. transitioning/transferring members from one care setting to another;
7. collaborating and coordinating with multi-disciplinary providers and community based organizations
8. adhering to Health Plan policies and regulatory agencies’ standards

Education and Experience
A current, active, unrestricted California Registered Nurse license
Minimum of 2 years as a practicing RN and working with children or adolescences in a hospital or outpatient setting
Minimum of 1 year in a managed care or health plan setting, Medi-Cal or Medicaid preferred
Minimum of 1 year in utilization management or case management preferred
Knowledge of InterQual or MCG guidelines
Must be computer proficient

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