RN Case Manager: Acute Care Utilization & Coordination

University of California, Irvine; Irvine (CA); Remote; USD 110,000 - 140,000; Full time

Job summary

University of California, Irvine Health seeks an experienced Utilization Management professional to oversee hospital admissions and concurrent review. You will coordinate resource use, review clinical documentation, and collaborate with physicians and payors to ensure appropriate care levels.

The role requires extensive knowledge of InterQual/MCG criteria, strong communication, and a clinical background as a current RN with BSN.

Qualifications

• Familiarity with acute-care utilization management criteria and decision-support tools.
• Excellent written and verbal communication in English.
• Knowledge of payer authorization and concurrent review processes.

Responsibilities

• Implement utilization management for hospital admissions and concurrent review using approved criteria.
• Monitor resource utilization and coordinate across the health system.
• Collaborate with physicians, payors, and care teams to ensure accurate documentation and appropriate level of care.

Skills

InterQual/MCG criteria knowledge

Communication skills

Customer service skills

Multitasking/Time management

Documentation accuracy

Education

Bachelor of Science in Nursing

RN License

Tools

Microsoft Office

Job description

University of California, Irvine Health seeks an experienced Utilization Management professional to oversee hospital admissions and concurrent review. You will coordinate resource use, review clinical documentation, and collaborate with physicians and payors to ensure appropriate care levels.

The role requires extensive knowledge of InterQual/MCG criteria, strong communication, and a clinical background as a current RN with BSN.