[Hiring] Per Diem RN Case Manager @University of California, Irvine

Role Description

Incumbent is responsible for implementing the utilization management process for patients admitted to the hospital. Monitors and coordinates resource utilization throughout the health system and evaluates services provided. Performs inpatient admission and concurrent review functions utilizing medical staff-approved decision support criteria (InterQual Intensity of Service, Severity of Illness criteria). Reviews clinical documentation, communicates with physician and other clinical staff to ensure documentation accurately reflects the patient’s severity of illness, and collaborates with health plans/payors by providing clinical information as required. Analyzes and identifies utilization patterns and trends and participates in denial prevention and management, appeals, special studies, projects, audits, or routine utilization monitoring activities while ensuring compliance with applicable regulatory, payer and organizational requirements.

Qualifications

• 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.

Requirements

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

Benefits

• Medical insurance.
• Sick and vacation time.
• Retirement savings plans.
• Access to a number of discounts and perks.

Conditions of Employment

• Background Check and Live Scan.
• Employment Misconduct.
• Legal Right to Work in the United States.
• Vaccination Policies.
• Smoking and Tobacco Policy.
• Drug Free Environment.
• Misconduct Disclosure Requirement.
• California Child Abuse and Neglect Reporting Act.
• E-Verify.
• Pre-Placement Health Evaluation.

Closing Statement

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC Anti-Discrimination Policy. We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.

UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at [email protected] or at (949) 824-0500, Monday - Friday from 8:30 a.m. - 5:00 p.m.

Consideration for Work Authorization Sponsorship: Must be able to provide proof of work authorization.