Schedule: Hybrid | Remote on Mondays and Fridays; onsite Tuesday, Wednesday, and Thursday in Rancho Cucamonga, CA
Description: The Non-Routine Placement Nurse, RN is responsible for leading the coordination of complex and non-routine patient placements and transitions across the continuum of care. Reporting to the Supervisor, Non-Routine Placement, this role works closely with hospitals, Independent Physician Associations (IPAs), Skilled Nursing Facilities (SNFs), Congregate Living Health Facilities (CLHFs), and other post-acute providers to ensure timely, cost-effective, and high-quality care transitions.
This position serves as a clinical and operational liaison, facilitating appropriate level-of-care determinations, resolving placement barriers, and ensuring continuity of care for high-risk members. The Non-Routine Placement Nurse collaborates with transitional care management, discharge planning, and readmission prevention teams to oversee complex cases, maintain regulatory compliance, and support optimal patient outcomes.
What You Will Do: - Lead the coordination of complex or non-routine patient placements and discharges across facilities, service lines, and levels of care, ensuring timely and appropriate transitions.
- Serve as the primary point of contact for escalated or complex cases, ensuring timely follow-up, resolution, and communication of placement status and decisions.
- Facilitate transitions to higher or lower levels of care, including SNFs, CLHFs, and other post-acute settings, while supporting early discharge planning and transition readiness.
- ct as a senior advisor and liaison between internal teams and external partners to ensure effective communication, coordination, and alignment on member care needs and treatment plans.
- Review and assess clinical information received from the ITC department to determine appropriate placement based on patient acuity, service needs, and facility capabilities.
- Collaborate with case managers, social workers, providers, hospitals, IPAs, and post-acute partners to identify appropriate care pathways and resolve placement barriers.
- Monitor patient movement and throughput, proactively addressing delays and initiating escalation pathways when barriers or safety concerns arise.
- Review and acknowledge program referrals, assign cases to Non-Routine Placement Specialists (NRPS), and provide clinical oversight and direction on case progression.
- Provide education and guidance to case managers and team members regarding complex placements and discharge coordination processes.
- Maintain accurate and timely placement logs, referral tracking tools, and electronic medical records documenting case activities, barriers, challenges, and interventions.
- Ensure compliance with regulatory requirements and organizational standards, including CMS, HEDIS, CAHPS, and other quality measures.
- Participate in interdisciplinary huddles, throughput initiatives, and performance improvement activities focused on improving efficiency and patient outcomes.
- nalyze trends, identify gaps in placement processes, and recommend improvements to workflows, service delivery, and care coordination.
- Identify opportunities to improve operational efficiency through process improvements, innovation, and technology.
- Support outreach and relationship-building initiatives with contracted providers and external partners to strengthen collaboration and participation in care initiatives.
- Perform additional duties as needed to support health plan operations and departmental business objectives.
You Will Be Successful If: - You demonstrate strong clinical judgment and critical thinking when coordinating complex patient placements and transitions of care.
- You possess excellent communication, interpersonal, and organizational skills.
- You can effectively collaborate with multidisciplinary teams, healthcare providers, and external partners.
- You have strong analytical skills and can identify placement barriers, evaluate care options, and recommend appropriate solutions.
- You are a self-starter who can work independently while contributing effectively within a team environment.
- You demonstrate excellent time management, prioritization, and problem-solving abilities.
- You maintain a high degree of patience and professionalism when managing challenging or complex situations.
- You understand evidence-based clinical criteria and their application to placement and care coordination decisions.
- You are familiar with California Children Services (CCS) and healthcare delivery processes.
- You apply evidence-based communication techniques, including Motivational Interviewing or similar empathy-based strategies.
- You demonstrate cultural sensitivity and an understanding of the diverse communities served.
- You understand self-management philosophies and practices, particularly as they relate to chronic medical conditions.
- You recognize the impact of unmitigated bias and judgment on health outcomes and are committed to addressing both.
- You can effectively manage competing priorities while maintaining accuracy, compliance, and quality patient care.
What You Will Bring: - ssociate degree in Nursing from an accredited institution.
- ctive, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California Board of Registered Nursing (BRN).
- Minimum of two (2) years of experience in a healthcare delivery setting, specifically in an Acute Care Hospital or Skilled Nursing Facility.
- Strong knowledge of evidence-based clinical criteria, care coordination, and healthcare delivery processes.
- Understanding of California Children Services (CCS).
- Familiarity with Motivational Interviewing or similar evidence-based communication techniques.
- Strong analytical, organizational, interpersonal, and communication skills.
- Excellent time management and problem-solving abilities.
- bility to work independently and collaboratively in a team-oriented environment.
- Demonstrated patience, professionalism, cultural sensitivity, and sound clinical judgment.
Preferred Qualifications:
- Bachelor's degree in Nursing from an accredited institution.
- Experience working in a health plan setting.
- Valid California Driver's License.
