Case Manager - Utilization Management - Days(SAT/SUN 10 hour shifts) - PT

University of California, Irvine•Irvine, CA

About The Position

Position Summary: Incumbent is responsible for a high level assessment and reassessment process for the patient/family to set priorities, plan, organize, and implement care that is goal-directed toward self-care outcomes. Collaborates with an interdisciplinary approach to care facilitation to promote and coordinate the delivery of high quality, individualized, safe and cost-effective patient care, and transitions of care. Advocates for patient self-determination and choice. Practices cultural competence in evaluations and planning with awareness and respect for patient and family diversity. Monitors and coordinates resource utilization throughout the health system and evaluates services provided. Performs the appropriate utilization review functions utilizing medical staff-approved decision support criteria (InterQual Intensity of Service, Severity of Illness criteria). Concurrently intervenes to enhance patient quality outcomes where appropriate. Ensures clinical information in the medical record is clear and complete reflecting the patient's true severity of illness through interfacing with physicians to improve the overall quality of the clinical documentation.

Requirements

Must possess the skill, knowledge, and ability essential to the successful performance of assigned duties
Must possess complete understanding of acuity levels for specific patient population
Must demonstrate customer service skills appropriate to the job
Minimum 5 years of clinical experience and 1 year of previous Case Management experience or a UCI employee who meets the clinical requirements and has a BSN.
Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop-down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job
Familiarity of Joint Commission, CMS, CDPH and CCS requirements
Excellent written and verbal communication skills in English
Current RN License
Computer literacy and proficiency
All external candidates must have a Bachelor of Science in Nursing
Ability to manage multiple concurrent projects and maintain a work pace appropriate to the workload
Ability to establish and maintain effective working relationships across the Health System
Must be able to provide proof of work authorization

Nice To Haves

Knowledge of University policies and procedures
Knowledge of California Children's Services benefits authorization process (CCS)
CCM, ACM
Bilingual skills

Responsibilities

assessment and reassessment process for the patient/family to set priorities
plan, organize, and implement care that is goal-directed toward self-care outcomes
Collaborates with an interdisciplinary approach to care facilitation to promote and coordinate the delivery of high quality, individualized, safe and cost-effective patient care, and transitions of care
Advocates for patient self-determination and choice
Practices cultural competence in evaluations and planning with awareness and respect for patient and family diversity
Monitors and coordinates resource utilization throughout the health system and evaluates services provided
Performs the appropriate utilization review functions utilizing medical staff-approved decision support criteria (InterQual Intensity of Service, Severity of Illness criteria)
Concurrently intervenes to enhance patient quality outcomes where appropriate
Ensures clinical information in the medical record is clear and complete reflecting the patient's true severity of illness through interfacing with physicians to improve the overall quality of the clinical documentation.