RN Case Manager EX - Utilization Management - Days - PT - Remote

University of California, Irvine•Orange, CA

3d•Remote

About The Position

The RN Case Manager assesses and reassesses patients and families to set priorities, plan, organize, and implement care directed toward self-care outcomes. The position collaborates with an interdisciplinary team to facilitate care and coordinate high-quality, individualized, safe, and cost-effective patient care and transitions of care. The incumbent advocates for patient self-determination and choice, and incorporates cultural competence and respect for patient and family diversity into evaluations and planning. The role monitors and coordinates resource utilization throughout the health system and evaluates services provided. It performs utilization review functions using medical staff-approved decision-support criteria, including InterQual Intensity of Service and Severity of Illness criteria, and intervenes concurrently to enhance patient quality outcomes when appropriate. The RN Case Manager also works with physicians to improve clinical documentation and ensure the medical record clearly and completely reflects the patient's true severity of illness.

Requirements

Minimum 5 years of clinical experience and 1 year of previous Case Management experience, or be a UCI employee who meets the clinical requirements and has a BSN.
Current RN License.
All external candidates must have a Bachelor of Science in Nursing.
Understanding of acuity levels for the specific patient population.
Knowledge of standard office equipment, including a calculator, fax, and photocopier, and personal computers and software such as Windows, Excel, Access, Word, PowerPoint, internet, and email.
Windows computer skills, including proficient keyboarding and use of a mouse or keys, menus, scroll bars, folders, and copying operations; required upon employment or within the first two weeks.
Familiarity with Joint Commission, CMS, CDPH, and CCS requirements.
Excellent written and verbal communication skills in English.
Computer literacy and proficiency.
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.
Skill, knowledge, and ability essential to successful performance of assigned duties.
Customer service skills appropriate to the job.

Nice To Haves

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

Responsibilities

Assess and reassess patients and families to set priorities and plan, organize, and implement care directed toward self-care outcomes.
Collaborate with an interdisciplinary team to facilitate care and coordinate individualized, safe, high-quality, and cost-effective patient care and transitions of care.
Advocate for patient self-determination and choice.
Use cultural competence and respect for patient and family diversity in evaluation and planning.
Monitor and coordinate resource utilization across the health system and evaluate services provided.
Perform utilization review using medical staff-approved decision-support criteria, including InterQual Intensity of Service and Severity of Illness criteria.
Intervene concurrently when appropriate to enhance patient quality outcomes.
Interface with physicians to improve clinical documentation and ensure the medical record clearly and completely reflects the patient's true severity of illness.