(RN) Care Manager - Care Management - 140710

About the role

The RN Care Manager facilitates patient hospitalization from pre-admission through discharge, coordinating with physicians, nurses, social workers, and other healthcare providers to ensure medically appropriate and cost-effective care. They apply clinical expertise and medical appropriateness criteria to resource utilization and discharge planning.

Responsibilities

• Facilitate patient hospitalization from pre-admission through discharge
• Coordinate with physicians, nurses, social workers, and other healthcare providers
• Apply clinical expertise and medical appropriateness criteria to resource utilization and discharge planning
• Communicate with administration and healthcare team as needed
• Work various hours and locations based on business needs

Requirements

• Graduate from an accredited school of Registered Nursing
• Registered Nurse (RN) license issued by the State of California
• BART or BLS at time of hire with commitment to get BART within six (6) months of hire date
• Minimum of 3 years prior inpatient RN care manager experience in an acute care hospital, or a minimum of 3 years of inpatient RN experience in the acute care hospital setting with demonstrated expertise in discharge planning, interprofessional communication, knowledge of post-acute care resources, excellent organizational and time management skills, and ability to prioritize and manage multiple tasks simultaneously, or a minimum of 3 years combined inpatient RN care manager and inpatient RN experience in the acute care hospital setting, within the last 7 years
• Demonstrated utilization review/discharge planning experience
• Knowledge of the payer industry, resource management, reimbursement, and evidence-based clinical practice is essential
• Proficiency in Information Systems, databases, and computer programs, including MS Office: Word, Excel, Outlook, PowerPoint, etc.
• Proven fast and accurate typing and data entry skills
• Strongly skilled in conflict management and resolution
• Must possess strong interpersonal skills, leadership, negotiation skills, and knowledge of hospital operations

Qualifications

• BSN/MSN (Department will consider ADN candidates with a minimum of 3 years acute care inpatient RN case management experience)
• ACM and/or CCM certificate
• Med/Surg, progressive care, or ED clinical RN experience
• Strong utilization review and InterQual experience
• RN experience in a post-acute care facility or home health agency
• Familiar with Epic, ECIN (Allscripts), and/or Utilization Review / InterQual
• Knowledge of local payers and coverage, reimbursement, and evidence-based clinical nursing practice

Skills

• Strong interpersonal skills
• Leadership skills
• Negotiation skills
• Knowledge of hospital operations
• Conflict management and resolution skills

Benefits

UC San Diego offers a comprehensive benefits package including health insurance, retirement plans, and paid time off.

Pay

Annual Full Pay Range: $161,140 - $212,555 (will be prorated if the appointment percentage is less than 100%)

Schedule

Nights, 12-Hour Shifts, Monday-Friday, some weekends and holidays