(RN) Prior Authorization UM Case Manager - Hybrid - 141189

About the role

UC San Diego Health is a four-time Magnet-designated organization and has earned Magnet with Distinction from the American Nurses Credentialing Center (ANCC), reflecting a commitment to transformational leadership, professional nursing excellence, innovation, exceptional patient outcomes, and an empowering practice environment. The Population Health Care Connections Hub consists of a team of RN case managers who perform telephonic outreach to high‑risk patients to help prevent avoidable events. Most calls are for patients discharged from an acute inpatient stay and/or internal provider referrals for patients who may need additional help while at home. This role requires strong initiative, critical thinking skills, and previous case management experience. Previous experience with EPIC and Care Port is a plus. Knowledge of community resources is critical for care coordination, and a strong understanding of payers, community resources, DME, home health, and skilled nursing facilities in the area is essential for success.

Responsibilities

• Perform telephonic outreach to high‑risk patients following acute inpatient discharge or based on internal provider referrals.
• Coordinate care by connecting patients with community resources, payers, DME, home health, and skilled nursing facilities.
• Manage high‑risk patients post‑discharge to prevent avoidable events.
• Work with insurance companies to facilitate authorizations and coverage.
• Utilize EPIC and Care Port systems for documentation and care management.
• Maintain accurate records and communicate effectively with interdisciplinary teams.

Requirements

• Graduate of an accredited school of Nursing.
• Current RN license issued by the State of California.
• Minimum two (2) years of recent RN experience in inpatient case management.
• Minimum two (2) years of recent ambulatory RN case management experience.
• Proven background in managing high‑risk patients post‑discharge.
• Strong preference for experience in telephonic outreach with high‑risk patient populations and working with insurance companies.
• Proficiency with information systems and computer programs such as Word and Excel.
• Excellent interpersonal and communication skills.
• Ability to work effectively within a team environment.

Qualifications

• BSN or Master’s Degree in Nursing.
• ACM and/or CCM certification.
• Epic knowledge and experience.

Pay

Hiring Pay Scale: $161,172 – $212,558 per year.
Annual Full Pay Range: $161,173 – $212,558 (prorated if appointment percentage is less than 100%).
Hourly Equivalent: $77.19 – $101.80.

Schedule

Work Schedule: Days, 8‑hour shift, Monday‑Friday.
Hybrid arrangement: on‑site one day per week at Greenwich Drive (La Jolla) with the remainder remote.
Must be able to work various hours and locations based on business needs.