Case Manager (RN) - Utilization Management

Prime Healthcare•Montclair, CA

1d•Onsite

About The Position

Montclair Hospital Medical Center is a 106-bed acute care, not-for-profit community hospital, recognized for its quality and commitment to serving an underserved community. As a member of Prime Healthcare, the hospital offers opportunities to grow and make a difference. The Case Manager (RN) - Utilization Management is responsible for the quality and resource management of all patients admitted to the facility, from admission through the continuum of care. This role advocates for patients, promotes cost containment, and integrates healthcare providers for seamless care delivery. The position involves performing holistic and comprehensive admission and concurrent reviews of medical records to assess medical necessity, intensity of service, and severity of illness.

Requirements

Minimum 5 years' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license
At least one year experience in case management, discharge planning or nursing management
Experience and knowledge in basic to intermediate computer skills.

Nice To Haves

Five years of acute care nursing experience.
CCM or obtained within 1 year
Knowledge of Milliman Criteria and InterQual Criteria preferred.
Current BCLS certificate, preferred

Responsibilities

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management.
Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care.
The methodology is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.