RN Case Manager - Utilization & Care Coordination

UC Irvine

Irvine (CA)

On-site

USD 100,000 - 140,000

Full time

5 days ago

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Job summary

UCI Health in Irvine, CA seeks an experienced Utilization Management professional to implement and monitor utilization processes for hospitalized patients. You will review admissions, coordinate care across the health system, and work with payors to ensure compliant documentation and timely approvals.

The ideal candidate has 5+ years of acute care clinical experience with Case/Utilization Management, proficiency in InterQual/MCG, and strong communication in English.

Qualifications

InterQual and/or MCG criteria knowledge for utilization management.
Proficient with Microsoft Office (Excel, Word, PowerPoint, Access).
5+ years acute care clinical experience; 1 year in Case/Utilization Management.
Strong written and verbal English communication skills.

Responsibilities

Implement utilization management for admitted patients across the hospital system.
Monitor and coordinate resource utilization; analyze trends.
Perform inpatient admission and concurrent reviews using procedures like InterQual/MCG.
Review documentation to ensure accurate severity of illness reflection.
Collaborate with health plans/payors by sharing required clinical information.
Identify utilization patterns and participate in denial prevention, appeals, and audits.

Skills

InterQual

MCG

Microsoft Office

Acute care

Communication

Payer processes

Case Management

English fluency

Denial prevention

Education

Bachelor of Science in Nursing

RN License

BLS Certification

Tools

None

Job description

The ideal candidate has 5+ years of acute care clinical experience with Case/Utilization Management, proficiency in InterQual/MCG, and strong communication in English.

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