RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days

John Muir Health • Concord, NH

1d • $89 - $122

About The Position

The inpatient case manager serves as a patient advocate for appropriate utilization of resources. The role applies assessment, planning, implementation, monitoring, evaluation, and coordination of care to meet patients’ health care needs throughout hospitalization and transition back to the community, in coordination with the interdisciplinary health team.

The RN Case Manager functions within the full scope of nursing practice, with a specialized focus on care coordination, compliance, transition management, education, and utilization management. The position follows a fixed schedule: Week 1, Sunday–Wednesday; Week 2, Sunday–Thursday. The work shift is 08:00–16:30, with 36 scheduled hours per week.

The listed pay range is $89.23–$121.58 per hour. Offer amounts are based on demonstrated or relevant experience and/or licensure, and pay may be adjusted to the local market for hires outside the Bay Area.

Requirements

• Bachelor's degree from an accredited school of nursing.
• Registered Nurse license from the California Board of Nursing.
• Basic Life Support certification from the American Heart Association.
• Strong written and verbal communication skills.
• Strong knowledge of Medicare and Medi-Cal guidelines and benefit resources applicable to hospitalization and transition planning.
• Working knowledge of common diagnoses and procedures and their impact on patients, families, and the ability to manage care outside the hospital.
• Knowledge of individual and family development across the lifespan and the influence of cultural and spiritual values in health care.
• General knowledge of commercial coverage plans and commonly covered benefits.
• Understanding of reimbursement models and their impact on care delivery, patient management, and reimbursement, including ACOs, DRGs, and full-risk models.
• Understanding of criteria, rules, and regulations for inpatient, observation, and outpatient levels of patient management.
• Knowledge of geriatrics and the impact of aging on health and function, as well as working knowledge of chronic or progressive diseases such as CHF, COPD, diabetes, and end-stage renal disease.
• Understanding of the inpatient Social Worker role and palliative care resources.
• Ability to plan, organize, manage time, and prioritize work in collaboration with others.
• Ability to work independently and as part of a multidisciplinary team.
• Effective problem-solving and conflict-resolution skills.
• Ability to work respectfully and creatively with clients from diverse backgrounds while supporting autonomy and safety.
• Leadership skills to delegate, guide staff, and hold others accountable.
• Ability to learn and use computer programs including EPIC, MIDAS, Allscripts, and Microsoft Outlook.

Nice To Haves

• Two years of case management or equivalent work experience preferred.
• Three years of medical/surgical nursing experience preferred.
• Three years of critical care nursing experience preferred.
• Accredited Case Manager (ACM) certification from ACMA or Certified Case Manager (CCM) certification from CCMC strongly preferred.

Responsibilities

• Advocate for appropriate utilization of resources.
• Assess, plan, implement, monitor, evaluate, and coordinate care to meet patients’ health care needs during hospitalization and transition back to the community.
• Coordinate care in collaboration with the interdisciplinary health team.
• Provide care coordination, compliance, transition management, education, and utilization management within the full scope of nursing practice.
• Plan, organize, manage time, and prioritize work in collaboration with others.
• Work independently and as part of a multidisciplinary team.
• Motivate teams, delegate, provide direction and guidance to staff, and hold others accountable.
• Work respectfully and creatively with clients from diverse functional abilities and social, economic, and cultural backgrounds while supporting client autonomy and safety.

What This Job Offers

• Job Type: Full-time