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

The County of Riverside - Riverside University Health System-Medical Center is seeking highly skilled and experienced Registered Nurse to join our team as a Health System Nurse Case Manager with the UR Case Management Department located in Moreno Valley.

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 candidate's 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:
9/80, Monday to Friday, with every other Friday off
Hours: 8:00 am to 5:30 pm

Health System Nurse Case Manager I: $50.3605 - $77.9456 per hour Health System Nurse Case Manager II: $55.1731 - $83.1586 per hour

Meet the Team!At Riverside University Health System Medical Center, nursing is more than a job, it's an opportunity to make a real difference in a vibrant and diverse community.

Nationally recognized for its forward-thinking and innovative approach to patient care, RUHS Medical Center is also a proud teaching hospital and one of the top employers in the region.
Our 439-bed facility is a designated Level I Trauma Center, Primary Stroke Center, and home to the region's only Pediatric Intensive Care Unit (PICU).

Here, you'll gain valuable experience across a wide range of specialties, including trauma care, stroke, pediatrics, and critical care.
We are committed to your professional growth, offering continuous education, training, and career development programs in a collaborative, supportive, and rewarding environment.

Whether you're an experienced nurse or just starting your career, RUHS Medical Center provides unparalleled opportunities to learn, grow, and make a meaningful impact.
Could you see yourself making a difference here?
Discover more about RUHS Medical Center at www.ruhealth.org .• 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 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.

• Provide and coordinate community-based medical post-discharge act...