Case Manager (RN) - Utilization Management

About the Organization

Chino Valley Medical Center is a 112-bed community hospital established in 1972 and centrally located in Southern California’s Chino Valley. A nine-time recipient of the Healthgrades Patient Safety Excellence Award (2014-2022), Chino Valley Medical Center has been recognized nationally for its quality, including as among the 100 Great Community Hospitals by Becker’s Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. The hospital is committed to serving the community’s health care needs with top-rated emergency care as well as senior services, orthopedics, surgical services, and more.

As a member of Prime Healthcare, Chino Valley Medical Center offers opportunities to expand your horizons and be part of a community dedicated to making a difference.

Responsibilities

• Responsible for the quality and resource management of all patients admitted to the facility from the point of admission and across the continuum of health care management.
• Works on behalf of the advocate, promoting cost containment and demonstrating leadership to integrate health care providers for a seamless delivery of care.
• Ensures the achievement of quality, clinical, and cost-effective outcomes.
• Performs a holistic and comprehensive admission and concurrent review of the medical record for medical necessity, intensity of service, and severity of illness.

Requirements

• Minimum 5 years' work experience post-graduation from an accredited school of nursing and a current state Registered Nurse license.
• At least one year of experience in case management, discharge planning, or nursing management.
• Experience and knowledge in basic to intermediate computer skills.

Preferred Qualifications

• Five years of acute care nursing experience.
• Certified Case Manager (CCM) certification or obtained within 1 year of hire.
• Knowledge of Milliman Criteria and InterQual Criteria.
• Current BCLS certificate.

Benefits

• Paid Time Off
• 401K retirement plan
• Medical, dental, and vision coverage
• Tuition reimbursement
• Voluntary benefit options

Benefits may vary based on collective bargaining agreement requirements and/or employment status (full-time or part-time).

Pay

A reasonable compensation estimate for this role is $43.25 to $58.21 per hour. The exact starting compensation will be determined based on factors such as skillset, years of applicable experience, education, credentials, and licensure.

Schedule

Full Time, Day Shift