Case Manager (RN) - Utilization Management

Chino Valley Medical Center • Chino, CA

1d

About The Position

The Case Manager (RN) is responsible for quality and resource management of patients admitted to the facility, from admission and throughout the continuum of health care management. The role advocates on behalf of patients, promotes cost containment, and demonstrates leadership in integrating health care providers to support seamless care delivery. The position facilitates quality, clinical, and cost-effective outcomes through holistic, comprehensive admission and concurrent medical-record reviews assessing medical necessity, intensity of service, and severity of illness.

Requirements

• At least five years of work experience after graduating from an accredited school of nursing.
• Current state Registered Nurse license.
• At least one year of experience in case management, discharge planning, or nursing management.
• Basic to intermediate computer skills and knowledge.

Nice To Haves

• Five years of acute care nursing experience.
• CCM certification, or obtain it within one year.
• Knowledge of Milliman Criteria and InterQual Criteria.
• Current BCLS certificate.

Responsibilities

• Manage the quality and use of resources for admitted patients from admission throughout the continuum of care.
• Advocate on behalf of patients and promote cost containment.
• Integrate health care providers to facilitate seamless delivery of care.
• Conduct holistic and comprehensive admission and concurrent medical-record reviews for medical necessity, intensity of service, and severity of illness.
• Facilitate quality, clinical, and cost-effective outcomes.

What This Job Offers

• Career Level: Mid Level
• Education Level: No Education Listed