RN Case Manager - Utilization Review
About the role
St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the hospital for high quality and compassionate medical care. St. Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Surgical, Orthopedics, Obstetrics, Pediatrics, Behavioral Health, and Emergency and Trauma Care. In addition, the hospital offers a broad array of education and outreach programs that advance community health. St. Francis Medical Center is a Comprehensive Stroke Center, STEMI Receiving Center, ED Approved for Pediatrics, Geriatric ED, Level III Neonatal ICU, and Level II Trauma Center. Please visit www.stfrancismedicalcenter.com for more information. Join an award-winning team of dedicated professionals committed to compassion, quality, and service!
Responsibilities
Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.
Qualifications
- Minimum 5 years' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license
- At least one year experience in case management, discharge planning or nursing management
- Experience and knowledge in basic to intermediate computer skills
- Five years of acute care nursing experience (preferred)
- CCM certification or obtained within 1 year (preferred)
- Knowledge of Milliman Criteria and InterQual Criteria preferred
- Current BCLS certificate preferred
Benefits
- Paid time off
- 401K retirement plan
- Medical, dental, and vision coverage
- Tuition reimbursement
- Many more voluntary benefit options
Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time.
Pay
The current compensation range for this role is $47.20 to $63.45. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Schedule
Employment Status: Full Time; Shift Days: as scheduled.