Case Manager - Utilization Management

About the Role

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community. West Anaheim Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

Founded in 1964, West Anaheim Medical Center is a 219-bed acute-care hospital dedicated to providing the community with high-quality, compassionate healthcare. Key services include general medical and surgical inpatient care and treatment, emergency services, surgical services, behavioral health, comprehensive heart center, and diagnostic imaging.

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 healthcare management.
• Works on behalf of the advocate, promoting cost containment and demonstrating leadership to integrate healthcare providers for a seamless delivery of care.
• Facilitates and 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

Education, Experience, Training

• BSW or other bachelor's degree in a related field.
• At least one year of experience in case management, discharge planning, or nursing management; or
• Experience and knowledge in basic to intermediate computer skills.

Preferred Qualifications

• Minimum 5 years of acute care experience.
• CCM certification or obtained within 1 year.
• Current BCLS certificate.
• Knowledge of Milliman Criteria and InterQual Criteria.

Benefits

West Anaheim Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to:

• Paid time off
• 401K retirement plan
• Medical, dental, and vision coverage
• Tuition reimbursement
• Many more voluntary benefit options

Pay

A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $30.28 to $43.32 per hour. The exact starting compensation will be determined at the time of hire, considering factors such as skillset, years of applicable experience, education, credentials, and licensure.

Schedule

• Employment Status: Full Time
• Shift: Days