(RN) Case Manager - Per Diem - 134701

UC San Diego Health is a Magnet designated organization, which is a prestigious recognition that applies to only 10% of all U.S. hospitals. Magnet is the "gold standard" for nursing excellence and is based on strengths in five key areas, which include transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovation and improvements and empirical outcomes. UC San Diego Health has held its Magnet status since 2011.

Inpatient UM Case Manager is responsible for concurrent and retro review of inpatient admissions to acute hospitals, long term acute hospital, inpatient acute rehabilitation, skilled nursing facility. Inpatient UM Case Manager is responsible for consistently applying MCG evidence based guidelines to determine the need for admission to the hospital or skilled nursing facility and continued stay. Inpatient UM case Manager is responsible for timely communication with in network and out of network hospitals to start discharge planning at the time of admission. Inpatient UM Case Manager is responsible to escalate cases not meeting MCG criteria or complex cases to the Medical Director for decision.

Inpatient UM Case Manager is responsible for authorizing DME, HH, SNF, LTACH, ARU services as part of discharge planning. Inpatient UM Case Manager acts as part of interdisciplinary care team, which includes medical directors, doctors, nurses, inpatient case managers, social workers, outpatient case managers, complex case managers, clinical support staff, administrative provider relations and other internal and external stake holders.

While not required, a cover letter is highly recommended when applying to this position.

• Must be a graduate from an accredited school of Nursing.
• RN license issued by the State of California.
• Experience working as an Inpatient Case Manager performing concurrent utilization review and retro review.
• Experience using MCG guidelines - inpatient and observation criteria.
• Working knowledge and experience with members with Medicare/Med-Cal HMOs and benefits as well as commercial HMO health plan policies. Working knowledge and experience with DOFRs.
• Proficiency in Information Systems and computer programs such as Word and Excel.
• Must possess excellent interpersonal and communication skills.
• Must be able to work within a team environment

• Three to five (3 - 5) years of experience working within IPA/MSO/Health Plan as Inpatient Case Manager - concurrent review and strong discharge planning skills.
• BSN or Master's Degree.
• ACM and/or CCM certificate.
• Epic knowledge and experience.

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.