RN Case Manager: Utilization & Care Coordination

University of California, Irvine; Orange (CA); Remote; USD 90,000 - 140,000; Full time

Job summary

UCI Health in Orange County seeks a registered nurse to oversee utilization management for hospitalized patients, coordinating resource use across the health system and ensuring documentation supports clinical and payer requirements. The role requires a BSN, 5+ years clinical experience with at least 1 year in case management, excellent communication, and proficiency in MS Office and common EHR systems.

You will collaborate with physicians, payors, and care teams to promote safe, cost-effective

Qualifications

• Minimum 5 years of clinical experience and 1 year in case management.
• BSN required and current RN license.
• Familiarity with InterQual utilization criteria.

Responsibilities

• Perform inpatient admission and concurrent review using InterQual criteria.
• Coordinate utilization management across the health system and communicate with physicians.
• Ensure documentation reflects severity of illness and supports payer requirements.

Skills

Case Management

Clinical Experience

Customer Service

MS Windows / Office

Excellent Communication

English Proficiency

Time Management

Education

Bachelor of Science in Nursing (BSN)

Tools

MS Office Suite

Excel

Access

PowerPoint

EHR Systems

Job description

UCI Health in Orange County seeks a registered nurse to oversee utilization management for hospitalized patients, coordinating resource use across the health system and ensuring documentation supports clinical and payer requirements. The role requires a BSN, 5+ years clinical experience with at least 1 year in case management, excellent communication, and proficiency in MS Office and common EHR systems.

You will collaborate with physicians, payors, and care teams to promote safe, cost-effective