Case Manager - Utilization Management

West Anaheim Medical Center; Anaheim (CA); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

paid time off

a 401K retirement plan

medical

dental

vision coverage

tuition reimbursement

Job summary

West Anaheim Medical Center in Anaheim, CA, a 219-bed acute-care facility, seeks a driven professional to manage admissions and coordinate care across the patient journey, promoting quality, cost containment and seamless collaboration among care teams.

The role targets a Bachelor’s degree in a related field with case management or discharge planning experience, plus solid computer skills; preferred CCM or equivalent certification, and readiness for ongoing professional development.

Qualifications

• BSW or other bachelor's degree in a related field; at least one year experience in case management, discharge planning or nursing management; or
• Experience and knowledge in basic to intermediate computer skills.

Responsibilities

• Quality and resource management of all patients admitted to the facility across the care continuum.
• Lead cost containment and integrate health care providers to achieve seamless delivery of care.

Skills

Case management experience

Discharge planning

Nursing management

Computer skills

Interdisciplinary collaboration

Education

BSW or related bachelor’s degree

Tools

Milliman Criteria

InterQual Criteria

Job description

Overview

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! West Anaheim Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

Founded in 1964, West Anaheim Medical Center is a 219-bed acute-care hospital dedicated to providing the community with high-quality, compassionate healthcare. Key services include general medical and surgical inpatient care and treatment, emergency services, surgical services, behavioral health, comprehensive heart center, and diagnostic imaging. For more information visit www.westanaheimmedctr.com.

Responsibilities

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required Qualifications

• BSW or other bachelor's degree in a related field. At least one year experience in case management, discharge planning or nursing management; or
• Experience and knowledge in basic to intermediate computer skills.

Preferred Qualifications

• Minimum 5 years of acute care experience preferred.
• CCM or obtained within 1year
• Current BCLS certificate preferred.
• Knowledge of Milliman Criteria and InterQual Criteria preferred.

Pay Transparency

West Anaheim Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.

• paid time off
• a 401K retirement plan
• medical
• dental
• vision coverage
• tuition reimbursement
• many more voluntary benefit options

A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $30.28 to $43.32. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf