On-Call Registered Nurse at LSMA Management Inc

San Bernardino, California, United States -

Full Time

Start Date

Immediate

Expiry Date

05 Aug, 26

Salary

0.0

Posted On

07 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization Management, Care Coordination, Discharge Planning, Medical Necessity Determination, Clinical Judgment, Critical Thinking, Problem Solving, Professional Communication, Electronic Medical Records, Microsoft Office, ICD-10, CPT, HCPCS

Industry

Health and Human Services

Description

Description JOB SUMMARY: The On-Call Registered Nurse (RN) is a California-licensed registered nurse responsible for providing after-hours medical management coverage when the Medical Management office is closed. The role supports utilization management (UM), care coordination, discharge processing, and urgent authorization activities, ensuring continuity of care, appropriate utilization of services, and compliance with applicable federal, state, accreditation, and health plan requirements within a healthcare MSO environment. Requirements MINIMUM & PREFERRED QUALIFICATIONS: Education/Training Minimum: Graduated from an accredited Registered Nursing program. Preferred: Bachelor of Science in Nursing (BSN) Experience Minimum: One year of clinical experience as a Registered Nurse. Preferred: One to two years of experience in utilization management, case management, discharge planning, MSO/IPA, or health plan settings. Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position. Certification(s) Current state Registered Nursing license. Skills, Knowledge & Abilities · Knowledge of utilization management principles, medical necessity determination, and regulatory requirements relevant to managed care. · Familiarity with Milliman Care Guidelines, CMS requirements, NCQA standards, and delegated UM workflows. · Basic understanding of ICD-10, CPT, and HCPCS coding. · Strong clinical judgment, critical thinking, and problem-solving skills within RN scope of practice. · Effective verbal and written communication skills, including professional interaction with physicians and clinical leadership. · Ability to independently prioritize and manage multiple urgent tasks during on-call hours. · Proficiency with electronic medical records, utilization management platforms, and Microsoft Office applications. PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS: The physical, mental, and environmental demands described below are representative of those required to perform the essential functions of this position, with or without reasonable accommodation. The role involves primarily sedentary work with extended periods of sitting, screen time, typing, and telephone use, along with occasional standing, walking, bending, and lifting of materials up to 20 pounds. The position requires sustained mental focus to evaluate complex clinical information and make timely, sound decisions during on-call hours, as well as the ability to work evenings, nights, weekends, and holidays in accordance with assigned on-call schedules.

Responsibilities

Provide after-hours medical management coverage, including utilization management and urgent authorization activities. Ensure continuity of care and compliance with federal, state, and health plan requirements within an MSO environment.