Job Title: Remote RN – High Level of Care Transfers (Temp-to-Perm)

Pay Rate: $40-$42/hr
Schedule: Monday – Friday, 8:00 AM – 5:00 PM PST
Location: Remote, but candidate must reside in California and hold a valid CA RN license

Job Description:
A Managed Care Organization is seeking an experienced Registered Nurse to assist with high level of care (HLOC) reviews and complex discharge planning. The RN will work closely with hospital staff to facilitate seamless transfers of complex care members to appropriate higher-level care facilities. The role requires strong clinical expertise, knowledge of MCG inpatient criteria, and experience navigating hospital networks, provider groups, and delegation agreements. This is a temp-to-hire opportunity, with the potential for long-term placement based on performance and business needs.

Key Responsibilities:

• Review high level of care transfers for complex care members.

• Assist the Complex Discharge Unit in ensuring appropriate member placements.

• Collaborate with transferring and receiving hospital staff, including nurses, attending physicians, and administrative personnel.

• Utilize MCG inpatient criteria to assess transfer needs and ensure the highest quality of care.

• Work with Independent Physician Associations (IPAs) and delegated provider networks to facilitate transitions.

• Identify in-network hospitals for transfers whenever possible to optimize plan resources.

• Assist in the repatriation of members back into the network.

• Communicate effectively with all stakeholders, ensuring clarity and efficiency in the transfer process.

• Maintain high accountability in ensuring safe, effective, and efficient member transitions.

Required Skills & Qualifications:

• Active CA Registered Nurse (RN) license.

• Reside in California.

• Minimum of 5 years of clinical experience in an ICU or ER setting.

• Strong clinical skills to assess member acuity and transfer needs.

• Comprehensive understanding of MCG inpatient criteria for critical care diagnoses.

• Experience with managed care, hospital networks, and provider delegations preferred.

• Prior experience in repatriation and hospital transfers is highly desirable.

• Strong communication skills and ability to interact with a variety of healthcare professionals.

• High level of accountability in managing complex care transitions.

Preferred Experience:

• Prior experience working within a managed care organization.

• Experience in hospital case management or discharge planning.

Additional Information:

• This is a temp-to-perm position based on performance and business needs.

• Candidates must demonstrate efficiency in complex discharge planning and transfer coordination.