Case Manager (RN) - Utilization Management

Prime Healthcare • Chino, CA

1d

About The Position

The Case Manager is responsible for quality and resource management for 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 provides leadership to integrate health care providers for seamless care delivery. The position facilitates quality, clinical, and cost-effective outcomes by conducting holistic and comprehensive admission and concurrent medical-record reviews for medical necessity, intensity of service, and severity of illness.

Requirements

• A BSW or another bachelor's degree in a related field.
• At least one year of experience in case management, discharge planning, or nursing management; alternatively, experience and knowledge in basic to intermediate computer skills.

Nice To Haves

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

Responsibilities

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

Benefits

• Paid time off
• 401K retirement plan
• Medical coverage
• Dental coverage
• Vision coverage
• Tuition reimbursement
• Voluntary benefit options

What This Job Offers

• Job Type: Full-time