Case Manager (RN) - Utilization Management

Prime Healthcare • Chino, CA

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About The Position

Chino Valley Medical Center, a member of Prime Healthcare, is seeking a Case Manager (RN) for Utilization Management. The hospital is a 112-bed community hospital in Southern California’s Chino Valley, serving community health care needs through emergency care, senior services, orthopedics, surgical services, and other services.

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 work is designed to support quality, clinical, and cost-effective outcomes through holistic, comprehensive admission and concurrent medical-record reviews for 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 (RN) 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.
• Certified Case Manager (CCM) certification, or ability to obtain it within one year.
• Knowledge of Milliman Criteria and InterQual Criteria.
• Current Basic Cardiac Life Support (BCLS) certificate.

Responsibilities

• Manage the quality and resources of patients admitted to the facility from admission throughout the continuum of health care management.
• Advocate on behalf of patients and promote cost containment.
• Provide leadership to integrate health care providers and support 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 and support quality, clinical, and cost-effective outcomes.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed