RN Case Manager: Utilization & Care Coordination

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

Benefits offered by this job

Medical insurance

Paid time off

Retirement plans

Job summary

UCI Health in Irvine, CA, is seeking an experienced Registered Nurse to lead utilization management for admitted patients. You will monitor resource use, perform concurrent reviews using InterQual criteria, and communicate with physicians to ensure accurate illness severity documentation.

The role requires 5+ years of acute-care nursing experience, knowledge of payer processes, and strong collaboration with health plans. A BSN and active RN license are preferred.

Qualifications

• Knowledge of acute-care utilization management criteria and decision-support tools like InterQual/MCG.
• Proficient in Microsoft Office suite (Excel, Word, PowerPoint, Access).
• Excellent communication skills and ability to work with clinical staff and payors.

Responsibilities

• Implement the utilization management process for admitted hospital patients and monitor resource use.
• Perform inpatient admission and concurrent review using InterQual criteria.
• Review clinical documentation and communicate with physicians to reflect illness severity.
• Collaborate with health plans by providing required clinical information.
• Analyze utilization patterns and participate in denial prevention and routine monitoring.

Skills

InterQual / MCG knowledge

Microsoft Office

Clinical acuity assessment

Excellent written and verbal comms

Project management

Team collaboration

Physician communication

Education

Bachelor of Science Nursing Degree

Tools

Microsoft Office

Job description

UCI Health in Irvine, CA, is seeking an experienced Registered Nurse to lead utilization management for admitted patients. You will monitor resource use, perform concurrent reviews using InterQual criteria, and communicate with physicians to ensure accurate illness severity documentation.

The role requires 5+ years of acute-care nursing experience, knowledge of payer processes, and strong collaboration with health plans. A BSN and active RN license are preferred.