Health System Nurse Case Manager III - RUHS Medical Center - Utilization ReviewCase Management
Health System Nurse Case Manager III - RUHS Medical Center - Utilization ReviewCase Management
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
$ 100713 - 166316
1 Vacancy
Job Description
ABOUT THE POSITION
- The County of Riverside Riverside University Health SystemMedical Center is seeking highly skilled and experienced Registered Nurses to join our team as a Health System Nurse Case Manager with the UR Case Management Department.The most competitive candidates for this role will have a strong background in hospital case management and utilization review management. Experience with or a thorough knowledge of InterQual criteria is highly preferred as it will enhance the candidates ability to evaluate and coordinate care effectively.
Highly Preferred Qualifications:- Acute Hospital Case Management and Utilization Review experience is highly preferred.
- Case Manager Certification (CCM)
- Interqual experience/Interqual certification a plus
- Knowledge in electronic health record systems (EPIC)
- Knowledge of healthcare regulations and reimbursement processes.
Work Schedule:- 5/40 Monday to Friday Hours: 8:30 am to 5:00 pm
- Night Shift 6/12 & 1/8 schedule; Hours: 7:00 pm to 7:30 am
- Including weekends and holidays
Meet the Team!
To find out more about Riverside University Health System please visit: EXAMPLES OF ESSENTIAL DUTIES
- Within the full scope of the Nursing Practice Act plan implement coordinate monitor and evaluate medical services; provide nursing case management discharge planning and utilization review services to patients; act as department resource for medical inquiries claim file reviews and utilization review.
Coordinate and monitor patients through the hospitalization process utilizing physicians nurses other healthcare providers and thirdparty payors to maintain quality care and fiscal responsibility; monitor completion of healthcare services to avoid delays in care and discharge; facilitate third party reimbursement approval and/or authorization.
Provide and coordinate communitybased medical postdischarge activities for patients provide early medical management intervention for new patient illness/disease consulting on medical only files and utilization review on all requests for medical treatment; review the posthospital care plan with the patient/family; follow plan through to discharge.
Evaluate healthcare services of requesting physicians based on the appropriateness of the service and the level of care at which service would be delivered; act as a neutral advocate for patients; act as a resource to physicians for adequate medical record documentation appropriateness of facility services as they relate to diagnoses and options for postdischarge care.
Perform utilization review in concert with the utilization review physician to approve delay modify or deny treatment.
Perform medical reviews on patient services claims and provide recommendations which are preemptive and focused on moving the patient along the healing continuum.
Apply clinical expertise as a resource to case management staff physicians nurses and other healthcare providers to identify the best results while coordinating the appropriate resource utilization; identify and manage patient problems to eliminate duplication and fragmentation of healthcare services.
Counsel and advise patients regarding proper healthcare methods.
Assist in the development of policies and procedures standards of care and practice and in the monitoring of those standards to ensure regulatory compliance as required by the Joint Commission Centers for Medicare and Medicaid Services and the State of California Department of Health Care Services.
Prepare and maintain concise complete records and reports including postdischarge documentation.
Promote collaboration among hospital interdisciplinary departments programs and physicians; represent the Case Management and Utilization Review Department when needed in hospital committee meetings.
Provide orientation and training to new staff; identify staff training needs.
Participate in quality assurance and performance improvement reviews.
May testify in court as to the clients mental and physical condition. MINIMUM QUALIFICATIONS
- Health System Nurse Case Manager I:
Health System Nurse Case Manager II:
Pay Range: $48.4236/hour to $74.9477/hourEducation: Successful completion of the coursework required to obtain a valid license to practice as a Registered Nurse in the State of California.
Experience: Three years of fulltime experience as a Registered Nurse in an acute care facility mental health facility or community health agency with references and evaluations to show appropriate skill level. Additional qualifying experience as a fulltime Licensed Vocational Nurse (LVN) may substitute for the required Registered Nurse experience up to three years on the basis of two years of fulltime experience as an LVN equaling one year of fulltime Registered Nurse experience. Licensed Vocational Nurse experience must be in an acute care setting within a hospital. One year of experience in Case Management and/or Utilization Review is preferred. (A bachelors degree from an accredited college or university in nursing may substitute for one year of the required experience.
Pay Range: $53.0510/hour to $79.9602/hourOption I:
Education: Successful completion of the coursework required to obtain a valid license to practice as a Registered Nurse in the State of California.
Experience: Four years of fulltime experience as a Registered Nurse in a managed care acute care facility mental health facility or community health agency setting that includes a minimum of one year of experience in Case Management and Utilization Review.
Option II:
Education: Graduation from an accredited college or university with a bachelors degree in nursing.
Experience: Three years of fulltime experience as a Registered Nurse in a managed care acute care facility mental health facility or community health agency setting that included experience in Case Management and Utilization Review.
Option III:
Education: Graduation from an accredited college or university with a masters degree in nursing.
Experience: Two years of fulltime experience as a Registered Nurse in a managed care acute care facility mental health facility or community health agency setting that included experience in Case Management and Utilization Review.
All Options:
Knowledge of: Case management and utilization review principles and practices; payor source documentation requirements and governmental regulations affecting reimbursement managed care and healthcare issues and standards; application of the nursing process; full range of Registered Nurse duties and responsibilities; community resources available to provide patient care and followup; federal state and local laws and regulations governing professional aspects of nursing; principles and methods of supervision and training; problem solving techniques.
Ability to: Plan organize supervise and evaluate nursing services on specific unit(s); communicate effectively; positively manage change and conflict; interpret licensure and accreditation standards; analyze and draft department policies and procedures; apply productive problemsolving skills; write clear and concise reports; perform Registered Nurse or public health nurse responsibilities according to the State of California Nursing Practice Act; implement the nursing process.
Other Requirements for Level I and II:
License: Must maintain a current valid license to practice as a Registered Nurse in the State of California.
Must possess a valid Basic Life Support (BLS) certification issued by the American Heart Association for professional healthcare providers.
Additional Requirement for Health System Nurse Case Manager II:
Certification: Must maintain a current and valid Case Manager Certificate.- Health System Nurse Case Manager I:
SUPPLEMENTAL INFORMATION
Whats Next
Open to All Applicants
This recruitment is open to all applicants.
Applicants who are current County of Riverside employees and/or current employees of the RUHS Division may be considered before other applicants depending on the volume of applications received.
Application Period
BASED ON THE NUMBER OF APPLICATIONS RECEIVED THIS POSTING MAY CLOSE WITHOUT NOTICE.
Applications received prior to the closing date will be considered based on the information submitted. Changes or alterations cannot be accepted. All applicants must submit a complete application by the closing date of this recruitment. No late applications will be permitted.
Include relevant work experience details on resume and/or application.
Applicants who fail to provide information demonstrating they possess the position requirements may not be considered further in the application process. A description of job duties directly copied from the job classification or job posting will not be considered.
Qualified applicants may be considered for future vacancies throughout the County.
Upload a copy of any license(s) official/unofficial transcript(s) degrees and/or related employment documents to your NeoGov account. If your education was completed outside of the United States you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services NACES or Association of International Credential Evaluators Inc. AICE.
For more information regarding this position please contact the recruiter Lisette Jimenez via email at.
APPLICATION INFORMATION
Veterans Preference
The County has a Veterans Preference Policy applicable to new hires. To qualify upload a copy of your (or your spouses) Member4 Form DD214 indicating dates of service and a copy of your spouses letter of disability (if applicable) with your application. For privacy reasons it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans Veterans Preference Policy C3 is available here: Accommodations
The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation please visit the Disability Access Office web page located at: of Education
If using education to qualify or when requested by the recruiter upload a copy of any license(s) official/unofficial transcript(s) degrees and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.If your education was completed outside of the United States you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services NACES or Association of International Credential Evaluators Inc. AICE.
Equal Opportunity Employer
The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race color religion sex national origin age disability sexual orientation gender gender identity gender expression marital status ancestry medical condition (cancer and genetic characteristics) genetic information or denial of medical and family care leave or any other nonjobrelated factors.PreEmployment
All employment offers are contingent upon successful completion of preemployment requirements including a criminal background investigation which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A preemployment physical examination and background check may be required.Probationary Period
As an Approved Local Merit System all County of Riverside employees except those serving At Will are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding County Resolution or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.General Information
Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies.Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.
Please read and follow any special application instructions on this posting. Click the Apply link located on this page to submit your application. For additional instructions on the application process examinations Veterans preference preemployment accommodation or other employment questions please refer to our web site .
If you are experiencing technical problems you may contact the applicant support desk Monday through Friday 6 am to 5 pm Pacific Time at or tollfree.
Required Experience:
Manager
Employment Type
Full-Time
