Case Manager, Utilization & Discharge Planning

University of California- Davis Health; Sacramento (CA); On-site; USD 103,000 - 153,000; Full time

Benefits offered by this job

Medical plans

Retirement plans

Paid time off

Job summary

UC Davis Health in Sacramento, CA is seeking a Clinical Case Manager to coordinate utilization review and discharge planning for patient care. The role requires clinical judgment, communication with providers and payors, and collaboration with multidisciplinary teams to ensure cost-effective, quality care.

The position emphasizes medical necessity assessments, data tracking on LOS and denials, and active engagement with internal/external providers to optimize services and discharge planning.

Qualifications

• Valid California Registered Nurse License without restriction.
• Graduation from an accredited school of nursing.
• Minimum of one (1) year recent Case Management experience in discharge planning and/or Utilization Review in an acute hospital.
• Knowledge of Medicare, Medi-Cal, and HMO legislation, third party payor contracts, Title XXII, the Joint Commission.
• Demonstrated ability to incorporate them into departmental systems/processes.
• Knowledge of professional and ethical standards related to Clinical Case Management such as the Nursing Practice Act, the Codes of Ethics from the American Nurses Association and the Standards of Practice & Scope of Services by the American Case Management Association.
• Ability to read and comprehend English text and medical terminology; knowledge of medical and nursing treatment plans, levels of care, and area resources; skill in assessing the appropriateness of medical admissions and continued stay.
• Skill to perform in-depth chart analysis to provide accurate information in a concise, informative manner, identify/analyze problems or issues related to areas of responsibility, developing an appropriate plan, and considering medical needs and resources available.
• Ability to organize and direct varied health care team professionals in a manner that establishes a good rapport and professional working relationship.
• Ability to work efficiently and independently, maintaining a calm manner while under pressure.
• Ability to organize work to accommodate special projects, deadlines and priorities; ability to be both flexible and adaptable in order to coordinate multiple variables and to respond to the need of a multi-faceted work area.
• Clinical skills and knowledge base to assess and refer to discharge planning, possible needs for care necessary to meet patient's needs on discharge.
• Knowledge and understanding of the need to utilize discretion and maintain confidentiality when discussing patient matters.
• Ability to successfully apply interpersonal communication skills in areas such as conflict management.

Responsibilities

• 30% - Utilization Review and Case Finding
• 30% - Coordination and Implementation of Discharge Plan
• 15% - Communication, Coordination and Documentation
• 10% - Secure Authorization for Care and Reimbursement for Hospital and Physician
• 10% - Denials and Appeals Management
• 5% - Quality and Education

Skills

RN license

Discharge planning

Utilization review

Communication skills

Interdisciplinary teamwork

Education

BSN

Tools

EHR systems

Job description

UC Davis Health in Sacramento, CA is seeking a Clinical Case Manager to coordinate utilization review and discharge planning for patient care. The role requires clinical judgment, communication with providers and payors, and collaboration with multidisciplinary teams to ensure cost-effective, quality care.

The position emphasizes medical necessity assessments, data tracking on LOS and denials, and active engagement with internal/external providers to optimize services and discharge planning.