RN Case Manager - AS Utilization Management - Full Time - 8 Hour - Days

John Muir Health; Walnut Creek (CA); On-site; USD 123,000 - 168,000; Full time

Job summary

John Muir Health in Walnut Creek is seeking an RN Inpatient Case Manager to advocate for appropriate utilization of resources and coordinate care from admission through transition back to the community. You will collaborate with the interdisciplinary team and operate within the full scope of nursing practice, with emphasis on care coordination, transition management, and utilization review.

The role is 0.9 FTE with a Tuesday-Saturday schedule (week 1) and Wednesday-Saturday (week 2), offering a

Qualifications

• Bachelor's Degree in Nursing required.
• 3 years Nursing - Medical/Surgical preferred or 3 years Nursing - Critical Care preferred.
• 2 years Care Coordination - Case Management preferred or equivalent work experience.
• RN license – California Board of Nursing required; BLS certification required.

Responsibilities

• Advocate for appropriate utilization of resources and coordinate care across hospitalization and transition to the community.
• Collaborate with the interdisciplinary health team to plan, implement, monitor and evaluate patient care.
• Coordinate care within the full scope of nursing practice with emphasis on care coordination, transition management, and utilization management.

Skills

Strong communication

Teamwork

Care coordination

Medicare knowledge

EPIC experience

Education

Bachelor's Degree in Nursing

Tools

EPIC

Allscripts

InterQual

Microsoft Outlook

Job description

Job Description: The role of the inpatient case manager is one of patient advocate of appropriate utilization of resources. The inpatient case manager applies the process of assessment, planning, implementation, monitoring, evaluation and coordination of care to meet the patient’s health care needs through hospitalization and transition back to the community and does this in coordination with the interdisciplinary health team. The RN Case Manager is expected to function within the full scope of the nursing practice with specialized focus on care coordination, compliance, transition management, education, and utilization management.

Education: Bachelor's Degree Accredited School of Nursing Required Experience: 3 years Nursing - Medical/Surgical Preferred or 3 years Nursing - Critical Care Preferred 2 years Care Coordination - Case Management Preferred or Equivalent Work Experience Certifications/Licensures: RN Registered Nursing - California Board of Nursing Required BLS Basic Life Support - American Heart Association Required ACM Accredited Case Manager - ACMA American Case Management Association or CCM Certified Case Manager - CCMC Commission for Case Manager Certification Strongly Preferred Skills: Strong written and verbal communication skills. Effectively motivates teams. Strong knowledge of Medicare and Medi-Cal guidelines and benefit resources as applicable to hospitalization and transition planning. Working know ledge of common diagnoses and procedures and the impact this w ill have to patients/families and their ability to manage their care outside of the hospital. Specialized know ledge may be required for certain areas of practice. Knowledge of individual and family development over the life span, and the influences of cultural and spiritual values in health care. General knowledge of commercial coverage plans and usually covered benefits. Strong understanding of various reimbursement models and impact to care delivery, patient management and reimbursements such as ACOs, DRGs, Full Risk, etc. Strong understanding of the criteria, rules and regulations around Inpatient, Observation and Outpatient levels of patient management. Strong know ledge of geriatrics and the impact to health and function in the aged as w ell as a working know ledge of chronic/progressive disease states such as CHF, COPD, Diabetes and End Stage Renal Disease, etc. Clear understanding of the role of the inpatient Social Worker and Palliative Care Resources. Ability to plan, organize, manage time and prioritize work in collaboration with others. Ability to work independently and as a part of a multidisciplinary team. Effective problem solving and conflict resolution skills. Ability to work respectfully and creatively with clients of diverse functional abilities, social, economic, and cultural backgrounds to support both client autonomy and client safety. Leadership skills to delegate and provide direction/guidance to staff and hold others accountable. Able to learn and work in a variety of computer programs, including EPIC, Allscripts, InterQual, and Microsoft Outlook.

This is a 0.9 FTE with a work schedule of Tuesday-Saturday (week 1), Wednesday-Saturday (week 2) Work Shift: 08.0 - 08:00 - 16:30 No Waive (United States of America) Pay Range: $89.23 - $121.58 Hourly Offer amounts are based on demonstrated/relevant experience and/or licensure. Pay will be adjusted to the local market if hired outside of the Bay Area. Note: Positions at JMH which are exempt (not eligible for overtime) under the level of Manager are listed as hourly for compensation purposes on this posting. The work shift will contain the word ‘exempt’ on it. Scheduled Weekly Hours: 36

John Muir Health is a nationally recognized, not-for-profit health care organization east of San Francisco serving patients in Contra Costa, Alameda and southern Solano Counties. It includes a network of more than 1,000 primary care and specialty physicians and 6,300 employees, The health system’s facilities include John Muir Health, Walnut Creek Medical Center (554-bed acute care facility), which serves as Contra Costa County's only designated trauma center, and John Muir Health, Concord Medical Center (247-bed acute care facility). Together, they are recognized as top centers for neurosciences, orthopedic, cancer, cardiovascular, trauma, emergency, pediatric, and high‑risk obstetrics care. Other areas of specialty include general surgery, robotic surgery, weight‑loss surgery, rehabilitation and critical care. In February 2024, John Muir Health opened the Behring Pavilion, which is home to the UCSF‑John Muir Health Jean and Ken Hofmann Cancer Center in Walnut Creek. This state‑of‑the‑art facility brings cancer prevention, diagnosis, treatment, and care coordination into one location. Patients benefit from the expertise of top cancer specialists from John Muir Health and UCSF Health and have access to the latest treatment advances close to home. John Muir Health also offers complete inpatient and outpatient behavioral health programs and services at our 73‑bed fully accredited psychiatric hospital and outpatient center located in Concord. In addition, John Muir Health provides a number of primary care and outpatient services at 89 practice sites throughout the community and urgent care centers in Berkeley, Brentwood, Concord, San Ramon and Walnut Creek.

John Muir Health offers a collaborative, patient‑centered health care environment with an emphasis on listening, explaining, and working together as a team, to help patients achieve their optimal health. We recognize those who exemplify excellence and reward them for contributing to our collective success. From individual to department to spontaneous recognition, Employee of the Month, Employee Suggestion Program rewards, Employee Success Sharing Program, and many more, we find unique ways to thank our employees for the outstanding efforts they make every day. Competitive salary and benefit package available.

At John Muir Health, we strive to be a leading health system through the cultivation of a culture of belonging where every patient, employee, provider, and community member feels safe and valued for embracing all aspects of their differences. As an Equal Opportunity employer, we encourage and consider all applicants for employment without regard to race, religion, national origin, gender, sexual orientation, gender identity, gender expression, age, veteran status, disability, or any other characteristic protected by law. For more information, please visit the EEO website here. All hospitals are accredited by The Joint Commission, a national surveyor of quality patient care. John Muir Health is an equal opportunity employer.