UM Case Manager II: Care Coordination & Outcomes

NorthBay Health; Fairfield (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

NorthBay Healthcare is seeking a Utilization Management Case Manager to coordinate patient care across the hospital and ambulatory settings. You will collaborate with physicians, staff, and Health Plans to authorize and monitor admissions and services, focusing on high-risk patients and cost-effective outcomes.

The role requires a California RN license and BSN, with strong knowledge of Health Plan rules. Experience in UM and hospital settings is preferred, and a collaborative team approach is

Qualifications

• RN licensed in California and BSN; hospital setting experience preferred.
• Knowledge of Health Plan rules and regulations.
• Strong communication and coordination abilities.

Responsibilities

• Coordinates care across ambulatory, hospital and ancillary services to ensure appropriate level of care.
• Serves as liaison with Health Plans and physicians.
• Authorizes and monitors admissions and services.
• Identifies high-risk patients using assessment tools and reports.
• Collaborates with clinical staff and family to plan and evaluate care.
• Adheres to health plan criteria and system guidelines.
• Represents UM in interdepartmental coordination.
• Performs additional duties as assigned.

Skills

Acute hospital experience

Health Plan rules

Education

Graduate of an accredited school of nursing.

BSN

Job description

NorthBay Healthcare is seeking a Utilization Management Case Manager to coordinate patient care across the hospital and ambulatory settings. You will collaborate with physicians, staff, and Health Plans to authorize and monitor admissions and services, focusing on high-risk patients and cost-effective outcomes.

The role requires a California RN license and BSN, with strong knowledge of Health Plan rules. Experience in UM and hospital settings is preferred, and a collaborative team approach is