Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management

Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management (Internal Only)

Available to current Alameda Health System employees only.

• Location:
  
  San Leandro, CA
• Facility:
  John George Psychiatric Hospital
• Department: JGP Care Coordination
• Position Type:
  Services As Needed / Per Diem - Day
• Category:
  Nursing
• Pay Range: $89.32 - $131.08
• Requirement #:
• FTE: 0.01
• Posted:
  November 20, 2025

Under general direction, works in collaboration with treatment team and other disciplines to assure the appropriate admit status and medical necessity for admission, concurrent, and discharges, securing the appropriate documentation and planning for continuing care. Identifies care issues and conveys barriers to discharge to appropriate disciplines while intervening to assure progression in the treatment planning. Follows AHS (Alameda Health System) and Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of acute inpatient services.

Provides medical necessity and patient Care related documentation to non Medi‑Cal payor sources. Documents authorization status and patient care related significant details in EHR. All tasks can be completed virtually and with minimal supervision.

• Assures clinical interventions are appropriate for the admitting diagnosis and reflect the standard of care as defined by The Joint Commission, Centers for Medicare and Medicaid Services, and AHS and Behavioral Health Department of Alameda County Utilization Plan.
• Collaborates with the treatment team; reviews all inpatient admissions for appropriate admit status based on medical necessity criteria of Medi‑Cal and/or commercial insurances and ensures the patient is registered at the appropriate level of care.
• Communicates with treatment team members to provide continuity of care while supporting and maintaining the treatment team approach to ensure effective resource utilization.
• Actively participates in treatment team meetings to discuss discharge planning.
• During the initial review, screens for discharge needs and makes appropriate recommendations to ensure a safe transition to a post‑acute level of care.
• Initiates authorization and follow‑up process with Behavioral Health Department of Alameda County and AHS Admissions/Eligibility/Enrollment services for uninsured patients.
• Works with patient care team and vendors to procure DME (Durable Medical Equipment).
• Notifies denials to the attending MD and treatment team members via EHR.
• Reviews patient account notes in EHR as needed for account updates and insurance accuracy.
• Completes the DHCS PASSR for patients being referred to a SNF or Morton Bakar Center.
• Independently processes the denial Work Ques and Patient Account Work Ques in EHR.
• Identifies and escalates complex cases at the appropriate level and coordinates case conferences as needed.
• Actively participates in the quarterly URC meeting and discusses trends, patterns, and problem cases.
• Identifies high utilization risk patients and notifies the treatment team.
• Communicates with the treatment team via Care Management report and Likely no medical necessity report daily.
• Documents medical necessity and patient care related information in the identified fields in EHR.
• Maintains current knowledge of clinical practice and Utilization Management by literature review and membership in a professional organization.
• Maintains continuing education related to specialty or pursuing certification.
• Makes appropriate referrals to homecare specialists or social work when clinically indicated.
• Monitors ongoing patient care and makes suggestions to achieve optimal outcomes, based on evidence‑based best practice.
• Participates in outcome data monitoring and audits as needed.
• Performs concurrent reviews assigning acute, administrative and denied days as per ACBH concurrent review policy.
• Utilizes clinical knowledge and defined standards of care to proactively identify inappropriate resource consumption and reports as appropriate.

Education
:
Graduate of an accredited Nursing Program required;
Bachelor's degree in Nursing preferred.

Minimum Experience
:
Previous Behavioral…