You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

The Utilization Management Nurse supports patients through the continuum of care by collaborating with physicians, case managers, discharge planners, ancillary service providers, and community resources. This role ensures patients receive the most appropriate, cost-effective, and safe level of care.

Responsibilities / Job Duties

• Conduct inpatient reviews for patients with complex medical and social needs.
• Review inpatient admissions promptly, applying evidence-based guidelines to determine the level of care and continued stay.
• Coordinate care with contracted ancillary providers, community agencies, and IPA/MGs as necessary.
• Perform follow-up reviews in ambulatory or lower levels of care settings.
• Communicate effectively with patients, families, physicians, and care teams to support safe, coordinated care.
• Identify members needing complex or chronic case management post-discharge; facilitate warm handoffs to ambulatory care teams.
• Oversee daily activities of CCIP Coordinators.
• Record all communications and care activities in EZ-Cap and/or case management systems.
• Participate in multidisciplinary patient care conferences and rounds.
• Monitor, document, and report clinical criteria in line with UM policies and procedures.
• Track and report utilization patterns, including overutilization and underutilization.
• Refer cases as appropriate to the Quality Management department.
• Enter data for case management reporting.
• Provide regular updates on open cases to the Medical Director, Director of Healthcare Services, and UM Manager.

Minimum Education and Experience Qualification Requirements

Qualifications

• California RN or LVN
• 1-2 years of experience in UM
• Ability to work PST Hours and have reliable wifi

Schedule / Shift

Hours: Mon–Fri 8:00–5:00 PST or 8:30–5:00 (30-min lunch). Must be available through 5:00. No OT for Temps; may be considered after conversion to FTE.

Pay: RN ($45-$52/hr), LPN ($37-$42/hr)

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

^*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.