Case Manager EX- Utilization Management- FT Day Shift - University of California, Irvine

UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed, acute care hospital in in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Listed among America’s Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County.

To learn more about UCI Health, visit www.ucihealth.org.

Position Summary:

The incumbent is responsible for conducting thorough assessments and reassessments of patients and their families to establish priorities, plan, organize, and implement goal-directed care focused on self-care outcomes in addition to discharge planning. This role also includes overseeing the utilization management process for hospitalized patients. Key responsibilities include collaborating with an interdisciplinary team to facilitate high-quality, individualized, safe, and cost-effective patient care, as well as coordinating transitions of care. The incumbent advocates for patient self-determination and choice while practicing cultural competence and ensuring that care planning and evaluations are conducted with respect for patient and family diversity. This individual also monitors and coordinates resource utilization across the health system, evaluating the services provided and performing utilization review functions using medical staff-approved decision support criteria (e.g., InterQual Intensity of Service and Severity of Illness criteria). The incumbent will analyze and identify utilization patterns and trends, participate in data collection and analysis for denial processes, and engage in special studies, projects, audits, and routine utilization monitoring activities. Ensures that clinical information in the medical record is clear, complete, and accurately reflects the patient's severity of illness by working closely with physicians to enhance the overall quality of clinical documentation.

Total Compensation

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.

Required Qualifications:

• One (1) year discharge planning experience
• Must possess the skill, knowledge, and ability essential to the successful performance of assigned duties
• Must possess complete understanding of acuity levels for specific patient population
• Must demonstrate customer service skills appropriate to the job
• Minimum five (5) years of clinical experience and 1 year of previous Case Management experience or a UCI employee who meets the clinical requirements and has a BSN.
• Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop-down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job
• Familiarity of Joint Commission, CMS, CDPH and CCS requirements
• Experience with capitation reimbursement
• Excellent written and verbal communication skills in English
• Current RN License
• Computer literacy and proficiency with MS Office Products, including Word & Outlook
• All external candidates must have a Bachelor of Science in Nursing
• Ability to establish and maintain effective working relationships across the Health System

Preferred Qualifications:

• Knowledge of University policies and procedures
• Knowledge of California Children’s Services benefits authorization process (CCS)
• CCM, ACM or Case Management credentialing
• Bilingual skills
• Ability to manage multiple concurrent projects and maintain a work pace appropriate to the workload

Conditions of Employment:

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:

• Background Check and Live Scan
• Legal Right to Work in the United States
• Vaccination Policies
• Smoking and Tobacco Policy
• Drug Free Environment

The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.

• California Child Abuse and Neglect Reporting Act
• E-Verify
• Pre-Placement Health Evaluation

Details of each policy may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php

Closing Statement:

The University of California, Irvine is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC nondiscrimination policy.

We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.

UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at eec@uci.edu or at (949) 824-0500, Monday - Friday from 8:30 a.m. - 5:00 p.m.