Per Diem Remote RN — Utilization Case Manager

University-of-California,-Irvin

Orange (CA)

Remote

USD 110,000 - 140,000

Full time

6 days ago

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Job summary

UCI Health seeks an experienced nurse to implement utilization management for hospitalized patients. You will monitor resource use, review documentation and coordinate with physicians to reflect illness severity, while working with health plans to provide necessary clinical information.

Requirements include a BSN and an active RN license, plus 5 years of clinical experience and familiarity with regulatory standards.

Qualifications

Minimum 5 years of clinical experience and 1 year of Case Management experience or a UCI employee who meets the clinical requirements and has a BSN.
Knowledge of Joint Commission, CMS, CDPH and CCS requirements.
Excellent written and verbal communication skills in English.
Current RN License.
All external candidates must have a Bachelor of Science in Nursing.
Computer literacy with MS Windows, Excel, Access, Word, PowerPoint and internet/email.
Ability to manage multiple concurrent projects and maintain a suitable workload.
Ability to establish and maintain effective working relationships across the Health System.

Responsibilities

Implement utilization management process for hospitalized patients.
Monitor and coordinate resource utilization across the health system.
Review clinical documentation and communicate with physicians to ensure accurate reflection of severity of illness.
Collaborate with health plans/payors by providing clinical information as required.
Analyze utilization patterns and participate in denial prevention, appeals, and routine monitoring.