Health System Nurse Case Manager I/II - RUHS UR Case Management/Utilization Review

ABOUT THE POSITION

The County of Riverside - Riverside University Health System-Medical 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 will have three years of full time experience as a Registered Nurse in an acute care setting.

Additionally, candidates should have at least one year of experience in either conducting case management or processing utilization review of healthcare services.

A Bachelor's or Master's degree in Nursing is required for consideration as well.

Preferred Qualifications:


* Certification in Case Management (CCM)


* Experience with electronic health record systems (EPIC)


* Knowledge of healthcare regulations and reimbursement processes.

Work schedule:


* Night Shift - 6/12 & 1/8 schedule (three, twelve-hour shifts per work week and one alternating eight hour shift every other week)


* Hours: 7:00 pm to 7:30 am and one shift from 11:00 pm to 7:30 am


* Including weekends and holidays

Meet the Team!
To find out more about Riverside University Health System, please visit:
http://www.ruhealth.org

EXAMPLES OF ESSENTIAL DUTIES
Within the full scope of the Nursing Practice Act, assess, plan, organize, and provide nursing, case management and utilization review services for patients.

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 post-discharge care.

Perform utilization review in concert with the utilization review physician and make recommendations to approve, delay, modify, or deny treatment.

Coordinate and monitor patients through the hospitalization process utilizing physicians, nurses, other healthcare providers, and third party 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.

As directed, coordinate community-based medical post-discharge activities for patients; record and report significant changes in condition and general progress of patient, and provide preemptive recommendations.

Counsel and advise patients regarding proper healthcare methods; review the post-hospital care plan with the patient/family; follow plan through to discharge.

Prepare and maintain concise, complete records and reports, including post-discharge documentation.

May provide orientation and training to new staff; may identify staff training needs.

Participate in quality assurance and performance improvement reviews.

Participate in hospital utilization review committee activities.

May testify in court as to ...