Health System Nurse Case Manager I/II - RUHS UR Case Management Department - County of Riverside
Moreno Valley, CA 92551
About the Job
The County of Riverside - Riverside University Health System-Medical Center is seeking a Health System Nurse Case Manager to join the Integrated Care Management Department.
The most competitive candidates will have at least 3 (three) years of Registered Nursing experience working in an acute care setting, with at least 1 (one) year of case management or utilization review experience and a BSN or MSN Degree.
Work schedule:
Night Shift - 6/12 and 1/8 hour (three, twelve-hour days per work week and one alternating eight hour day every other week)
Hours: 7:00 pm to 7:30 am
Meet the Team!
http://www.ruhealth.org/en-us/medical-center/Pages/home.aspx
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 the client's mental and physical condition.
MINIMUM QUALIFICATIONS
Health System Nurse Case Manager I:
Pay Range: $46.12 to $71.38 per hour
Education: 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 full time 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. One year of experience in Case Management and/or Utilization Review is preferred. (Possession of a Master's degree from an accredited college or university in nursing may be considered in lieu of one year of experience.)
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 follow-up; 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 problem solving 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.
Health System Nurse Case Manager II:
Pay Range: $50.52 to $76.15 per hour
OPTION I
Education: Graduation from an accredited college or university with an Associate's degree in nursing.
Experience: Five years of full-time registered nurse experience in a managed care or acute care setting that includes a minimum of one year experience in Case Management and Utilization Review.
OPTION II
Education: Graduation from an accredited college or university with a Bachelor's degree in nursing.
Experience: Three years of full-time registered nurse experience in a managed care or acute care setting that included experience in Case Management and Utilization Review.
OPTION III
Education: Graduation from an accredited college or university with a Master's degree in nursing.
Experience: Two years of full-time registered nurse experience in a managed care setting that included experience in Case Management and Utilization Review.
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 follow-up; 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 problem solving 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 Both Levels I and II:
License: Must possess and maintain a current, valid license to practice as a Registered Nurse in the State of California.
Certification: Possess a current Basic Life Support (BLS) certification issued by the American Heart Association for professional healthcare providers.
Possession of a valid California Driver's License may be required.
Additional Requirement for Level II:
Certification: Must maintain a current and valid Case Manager Certification.
SUPPLEMENTAL INFORMATION
Veterans' Preference:
The County has a Veteran's Preference Policy. Upload a copy of your (or your spouse's) Member-4 Form DD-214 indicating dates of service, and a copy of your spouse's 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' preference. See the policy here .
What's Next?
This recruitment is open to all applicants.
Applicants who are current County of Riverside employees and/or current employees of the Department/Agency may be considered before other applicants depending on the volume of applications received.
Qualified applicants may be considered for future vacancies throughout the County.
Special application requirements: All applications must have an updated resume attached and must include relevant work experience detailed on resume and/or application.
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 questions regarding this recruitment contact the recruiter, Liz Jimenez: lijimenez@rivco.org /951-955-5561.
GENERAL APPLICATION INFORMATION:
Please read and follow any special application instructions on this posting. Click the 'Apply' link located on this page to submit your application. For instructions on the application process, examinations, Veteran's preference, pre-employment accommodation or other employment questions, please refer to our web site, www.rc-hr.com . A pre-employment physical examination and background check may be required.
MEDICAL/DENTAL/VISION INSURANCE: A choice of different medical, dental and visions plan are available to elect. The County provides a Flexible Benefit Credit contribution as governed by the applicable SEIU Memorandum of Understanding to contribute towards the cost of these plans.
Note: Employees on assignment through the Temporary Assignment Program (TAP) receive different benefits. See the list here .
MISCELLANEOUS RETIREMENT: County of Riverside has three retirement Tiers through the California Public Employees' Retirement System (CalPERS).
- Tier I (Classic Member - Formula 3% @ 60): Applicable to current and former County of Riverside local miscellaneous employees hired prior to 08/24/2012 and did not withdraw CalPERS contributions. The employee contribution is eight (8%) percent.
- Tier II (Classic Member - Formula 2% @ 60): Applicable to local miscellaneous employees 1) hired after 08/23/2012 through 12/31/2012; 2) Previously employed with another CalPERS contracting public agency or a reciprocal retirement system, with a break in service of less than six months between the separation date with the previous employer and the appointment date with the County of Riverside. The employee contribution is seven (7%) percent.
- Tier III (PEPRA New Member - Formula 2% @ 62): Applicable to CalPERS local miscellaneous new members hired on or after the implementation of the Public Employees' Pension Reform Act of 2013 (PEPRA) which took effect January 1, 2013. As of July 1, 2020, the employee contribution is 7.25% and subject to change annually.
A new member is defined as any of the following:
CalPERS refers to all members that do not fit within the definition of a new member as "classic members".
Contribution rates are subject to change based on the County of Riverside annual actuarial valuation.
Note:
This summary is for general information purposes only. Additional questions regarding retirement formulas can be sent to retirement@rivco.org or by calling the Benefits Information Line at (951) 955-4981,
Option 2.
If you have prior service credit with another CalPERS agency or within agencies, please contact CalPERS at (888) 225-7377 to determine which retirement tier would be applicable to you. CalPERS is governed by the Public Employees' Retirement Law. The Retirement Law is complex and subject to change. If there's any conflict between this summary and the law, the law will prevail over this summary.
DEFERRED COMPENSATION: Voluntary employee contribution with a choice between two 457 deferred compensation plan options.
VACATION ACCRUAL (Bi-Weekly Accrual):
0< 3 year = 80 Hours (10 Days)
4< 9 years = 120 Hours (15 Days)
10 or more years = 160 Hours (20 Days)
Maximum Vacation leave accumulation is 480 hours.
SICK LEAVE: Four (4) hours Sick Leave accrual per pay period with unlimited accrual.
HOLIDAYS: Normally 12 paid holidays per year.
BEREAVEMENT LEAVE: Allowed 5 days (3 days are County paid; 2 additional days can be taken from accrued Sick Leave balance).
BASIC LIFE INSURANCE: Equal to one times annual base salary not to exceed $50,000 of term life coverage. Premiums are paid by the County. Additional Supplemental Life plan is available for employee purchase.
DISABILITY: Short-term Disability benefit pays up to a maximum of $461.54 weekly, payable up to a maximum of 52 weeks.
POST RETIREMENT MEDICAL CONTRIBUTION: A monthly contribution is made by the County towards retiree health insurance offered through the County as governed by the applicable SEIU Memorandum of Understanding.
OTHER: There may be other benefit provisions as specified in the applicable Memorandum of Understanding. Please contact the recruiter listed on the job posting directly for more information.
