RN Case Manager - Utilization Review

Job TitleNurse Case ManagerJob DescriptionResponsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.QualificationsEducation, Experience, TrainingRequired Qualifications:Minimum 5 years' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse licenseAt least one year experience in case management, discharge planning or nursing managementExperience and knowledge in basic to intermediate computer skills.Preferred Qualifications:Five years of acute care nursing experience. preferredCCM or obtained within 1yearKnowledge of Milliman Criteria and InterQual Criteria preferred.Current BCLS certificate, preferredPay TransparencySt. Francis Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time. The current compensation range for this role is $47.20 to $63.45. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.Employment StatusFull TimeShiftEveningsEqual Employment OpportunityCompany is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: NoticePrivacy Notice for California Applicants: