Unrestricted, current RN license in state of employment
BSN preferred; CCM certification is a plus
Two years of clinical experience in discharge coordination
Experience in correctional or detention facilities
Maintains all required RN certifications and educational requirements
Responsibilities
Provide clinical review of various care referrals using utilization management criteria
Coordinate care with medical directors, providers, and community organizations
Review clinical documentation and claims for accuracy and compliance
Oversee discharge planning services and continuity of care arrangements
Support care management operations through policy compliance and relationship building
Benefits
Opportunity for professional growth in a specialized role
Engagement with diverse healthcare partners and community organizations
Impactful work in care coordination for vulnerable populations
Supportive environment for policy compliance and best practices
Potential for leadership development in discharge planning
Full Job Description
How you make a difference
The RN Discharge Planner Lead is responsible for daily clinical care coordination, utilization management, support, and care management activities in compliance with applicable nursing standards and regulatory requirements. The role provides clinical oversight of the discharge planning process for CalAIM-eligible individuals and supervises the health care delivery activities related to discharge planning and reporting. This position reviews and signs off on reentry care plans, conducts assessments, leads care coordination with managed care plans and community providers, and ensures compliance with Medi-Cal and CalAIM requirements. The role manages utilization review, pre-certification activities, claims review, and coordination with providers, hospitals, and facility personnel. The RN Discharge Planner Lead serves as the accountable clinician for the discharge planning process.
Key Responsibilities
Provide clinical review of off-site observation, outpatient, acute care, and pre-certification referrals while applying utilization management procedures and criteria.
Coordinate care with medical directors, providers, facility personnel, managed care plans, hospitals, and community organizations to support effective treatment and discharge planning.
Review clinical documentation, utilization records, claims, referrals, and medical review activities to ensure accuracy, compliance, and appropriate coding.
Oversee discharge planning services, including reentry care plan review, community resource coordination, appointment scheduling, release medications, and continuity of care arrangements.
Support care management operations through policy compliance, best practice development, utilization oversight, cost management, and relationship building with community and healthcare partners.
Qualifications & Requirements
Education
Unrestricted, current RN license in state of employment
BSN, CCM preferred.
Experience
Two (2) years' clinical experience with Discharge Coordination experience
