Per Diem RN: Case Management & Utilization Specialist

University of California - Irvine Health; Orange (CA); Remote; USD 120,000 - 150,000; Full time

Benefits offered by this job

Medical insurance

Retirement plans

Discounts and perks

Job summary

University of California, Irvine Health seeks an experienced utilization management professional to oversee inpatient resource use across the hospital system. The role emphasizes concurrent review using InterQual criteria, collaboration with physicians and payors, and continuous monitoring of documentation and trends to support appropriate patient care and regulatory compliance.

Strong communication and multi-project management skills are essential to balance clinical demands with payer

Qualifications

• Five years of clinical experience and at least one year in case management or as an eligible UCI employee meeting clinical requirements
• Current RN license and active nursing practice
• Bachelor of Science in Nursing required for external candidates
• Strong computer literacy with MS Windows applications (Excel, Access, Word, PowerPoint) and email
• Familiarity with Joint Commission, CMS, CDPH and CCS requirements
• Excellent written and verbal communication skills in English

Responsibilities

• Implement utilization management processes for admitted patients across the health system
• Monitor and coordinate resource utilization and review services using approved criteria
• Communicate with physicians and clinical staff to ensure accurate documentation of illness severity
• Collaborate with health plans/payors and perform denial prevention, appeals, and audits while ensuring regulatory compliance

Skills

Case management

Customer service

Communication

Multitasking

Education

Bachelor of Science in Nursing

CCM

ACM

Tools

MS Windows

Excel

Access

Word

PowerPoint

Internet

Email

Job description

University of California, Irvine Health seeks an experienced utilization management professional to oversee inpatient resource use across the hospital system. The role emphasizes concurrent review using InterQual criteria, collaboration with physicians and payors, and continuous monitoring of documentation and trends to support appropriate patient care and regulatory compliance.

Strong communication and multi-project management skills are essential to balance clinical demands with payer