Updated: May 13, 2024
Location: Placentia
Job Type:
Department: Case Management-PLA

UC Title: Case Manager, RN I PLA

Position Number: 41087487

Reports to: Dir, Case Management PLA

Working Title: Case Manager, RN I PLA

Cost Center: Case Management-PLA (421750)

Bargaining Unit: Non Rep Dragon

FLSA: Nonexempt

Date Created: 5/03/2024

Job Code: 007761

Hours: 10

Shift: Not Applicable

FTE: 0.25

Position Summary:

The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including:

* Utilization Management supporting medical necessity and denial prevention

* Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction

* Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care

* Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy

* Education provided to physicians, patients, families and caregivers

The individual's responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review, b) care coordination, c) transition planning assessment and reassessment, d) implementation or oversight of implementation of the transition plan, e) leading and facilitating multi-disciplinary patient care conferences, f) managing concurrent disputes, g) making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services, i) communicating with patients and families about the plan of care, j) collaborating with physicians, office staff and ancillary departments, k) leading and facilitating Complex Case Review, l) assuring patient education is completed to support post-acute needs , m) timely complete and concise documentation in Case Management system, n ) maintenance of accurate patient demographic and insurance information, o) identification and documentation of potentially avoidable days, p) identification and reporting over and underutilization, q) and other duties as assigned.

Total Compensation

In addition to the salary range listed below, 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 (https://www.hr.uci.edu/partnership/totalrewards/compensation.php) and

Benefits (https://careersucirvine.ttcportals.com/pages/benefits).

Required Qualifications:

Required qualifications include an active Registered Nurse license with at least two years acute hospital patient care experience. BSN preferred. Accredited Case Manager (ACM) preferred. Acute hospital case management experience preferred. Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast paced environment, critical thinking and problem solving skills and computer literacy.

Ability to establish and maintain effective working relationships across the Health System

Ability to maintain a work pace appropriate to the workload

Must demonstrate customer service skills appropriate to the job

Excellent written and verbal communication skills in English

Must possess the skill, knowledge and ability essential to the successful performance of assigned duties

Preferred Qualifications:

Knowledge of University and medical center organizations, policies, procedures and forms

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 advancing inclusive excellence. 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 [emailprotected] or at (949) 824-0500, Monday - Friday from 8:30 a.m. - 5:00 p.m.

Physical, Mental, & Environmental Demands

To comply with the Rehabilitation Act of 1973 the essential physical, mental and environmental requirements for this job are listed below. These are requirements normally expected to perform regular job duties. Incumbent must be able to successfully perform all of the functions of the job with or without reasonable accommodation.