RN Case Manager

About This Role

The RN Case Manager assesses and reassesses patients and families to plan and implement goal-directed care, promoting high quality and cost-effective patient care. This role involves interdisciplinary collaboration and utilization review to ensure optimal patient outcomes.

Responsibilities

• Perform a high level assessment and reassessment process for patients/family to set priorities, plan, organize, and implement care that is goal-directed toward self-care outcomes
• Collaborate with an interdisciplinary approach to care facilitation to promote and coordinate the delivery of high quality, individualized, safe and cost-effective patient care, and transitions of care
• Advocate for patient self-determination and choice
• Practice cultural competence in evaluations and planning with awareness and respect for patient and family diversity
• Monitor and coordinate resource utilization throughout the health system and evaluate services provided
• Perform appropriate utilization review functions utilizing medical staff-approved decision support criteria (InterQual Intensity of Service, Severity of Illness criteria)
• Concurrently intervene to enhance patient quality outcomes where appropriate
• Ensure clinical information in the medical record is clear and complete reflecting the patient’s true severity of illness through interfacing with physicians to improve the overall quality of the clinical documentation
• Manage multiple concurrent projects and maintain a work pace appropriate to the workload
• Facilitate and lead interdisciplinary rounds

Requirements

• Skill, knowledge, and ability essential to the successful performance of assigned duties
• Complete understanding of acuity levels for specific patient population
• Customer service skills appropriate to the job
• Minimum 5 years of clinical experience
• 1 year of previous Case Management experience or a UCI employee who meets the clinical requirements and has a BSN
• Familiarity of Joint Commission, CMS, CDPH and CCS requirements
• Excellent written and verbal communication skills in English
• Current RN License
• Computer literacy and proficiency
• Bachelor of Science in Nursing

Qualifications

• Bachelor of Science in Nursing
• Minimum 5 years of clinical experience and 1 year of previous Case Management experience

Nice to Have

• Knowledge of University policies and procedures
• Knowledge of California Children's Services benefits authorization process (CCS)
• CCM, ACM or Case Management credentialing

Skills

* Required skills

Benefits