County of Riverside
Health System Nurse Case Manager I/II - RUHS UR Case Management/Utilization Revi
County of Riverside, Moreno Valley, California, United States, 92551
The County of Riverside - Riverside University Health System-Medical Center is seeking highly skilled and experienced Registered Nurses to join our team as a Health System Nurse Case Manager with the UR Case Management Department.The most competitive candidates will have three years of full-time experience as a Registered Nurse in an acute care setting. Additionally, candidates should have at least one year of experience in either conducting case management or processing utilization review of healthcare services. A Bachelor's or Master's degree in Nursing is required for consideration as well.Preferred Qualifications:
Certification in Case Management (CCM)Experience with electronic health record systems (EPIC)Knowledge of healthcare regulations and reimbursement processes.Work schedule:
Night Shift
- 6/12 & 1/8 schedule (three, twelve-hour shifts per work week and one alternating eight-hour shift every other week)Hours: 7:00 pm to 7:30 am and one shift from 11:00 pm to 7:30 amIncluding weekends and holidays
Job Responsibilities:
Within the full scope of the Nursing Practice Act, assess, plan, organize, and provide nursing, case management and utilization review services for patients.Evaluate healthcare services of requesting physicians based on the appropriateness of the service and the level of care at which service would be delivered; act as a neutral advocate for patients; act as a resource to physicians for adequate medical record documentation, appropriateness of facility services as they relate to diagnoses, and options for post-discharge care.Perform utilization review in concert with the utilization review physician and make recommendations to approve, delay, modify, or deny treatment.Coordinate and monitor patients through the hospitalization process utilizing physicians, nurses, other healthcare providers, and third-party payors to maintain quality care and fiscal responsibility; monitor completion of healthcare services to avoid delays in care and discharge; facilitate third-party reimbursement approval and/or authorization.As directed, coordinate community-based medical post-discharge activities for patients; record and report significant changes in condition and general progress of patient, and provide preemptive recommendations.Counsel and advise patients regarding proper healthcare methods; review the post-hospital care plan with the patient/family; follow plan through to discharge.Prepare and maintain concise, complete records and reports, including post-discharge documentation.May provide orientation and training to new staff; may identify staff training needs.Participate in quality assurance and performance improvement reviews.Participate in hospital utilization review committee activities.May testify in court as to the client's mental and physical condition.Health System Nurse Case Manager I:
Pay Range: $48.4236 to $74.9477 per hourEducation: Successful completion of the coursework required to obtain a valid license to practice as a registered nurse in the State of California.Experience: Three years of full-time experience as a registered nurse in an acute care facility, mental health facility, or community health agency with references and evaluations to show appropriate skill level. One year of experience in Case Management and/or Utilization Review is preferred. (Possession of a Master's degree from an accredited college or university in nursing may be considered in lieu of one year of experience.)Health System Nurse Case Manager II:
Pay Range: $53.0510 to $79.9602 per hourOther Requirements for Both Levels I and II:
License: Must maintain a current, valid license to practice as a Registered Nurse in the State of California.Certification: Must maintain a valid Basic Life Support (BLS) certificate issued by the American Heart Association for professional healthcare providers.Possession of a valid California Driver's License may be required.What’s Next?
Open to All ApplicantsThis recruitment is open to all applicants.Applicants who are current County of Riverside employees and/or current employees of the RUHS Division may be considered before other applicants depending on the volume of applications received.Application Period:
BASED ON THE NUMBER OF APPLICATIONS RECEIVED, THIS POSTING MAY CLOSE WITHOUT NOTICE.Applications received prior to the closing date will be considered based on the information submitted. Changes or alterations cannot be accepted. All applicants must submit a complete application by the closing date of this recruitment. No late applications will be permitted.Qualified applicants may be considered for future vacancies throughout the County.Upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account. If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services (NACES) or Association of International Credential Evaluators, Inc. (AICE).For more information regarding this position, please contact the recruiter, Lisette Jimenez via email at
lijimenez@rivco.org .
#J-18808-Ljbffr
Certification in Case Management (CCM)Experience with electronic health record systems (EPIC)Knowledge of healthcare regulations and reimbursement processes.Work schedule:
Night Shift
- 6/12 & 1/8 schedule (three, twelve-hour shifts per work week and one alternating eight-hour shift every other week)Hours: 7:00 pm to 7:30 am and one shift from 11:00 pm to 7:30 amIncluding weekends and holidays
Job Responsibilities:
Within the full scope of the Nursing Practice Act, assess, plan, organize, and provide nursing, case management and utilization review services for patients.Evaluate healthcare services of requesting physicians based on the appropriateness of the service and the level of care at which service would be delivered; act as a neutral advocate for patients; act as a resource to physicians for adequate medical record documentation, appropriateness of facility services as they relate to diagnoses, and options for post-discharge care.Perform utilization review in concert with the utilization review physician and make recommendations to approve, delay, modify, or deny treatment.Coordinate and monitor patients through the hospitalization process utilizing physicians, nurses, other healthcare providers, and third-party payors to maintain quality care and fiscal responsibility; monitor completion of healthcare services to avoid delays in care and discharge; facilitate third-party reimbursement approval and/or authorization.As directed, coordinate community-based medical post-discharge activities for patients; record and report significant changes in condition and general progress of patient, and provide preemptive recommendations.Counsel and advise patients regarding proper healthcare methods; review the post-hospital care plan with the patient/family; follow plan through to discharge.Prepare and maintain concise, complete records and reports, including post-discharge documentation.May provide orientation and training to new staff; may identify staff training needs.Participate in quality assurance and performance improvement reviews.Participate in hospital utilization review committee activities.May testify in court as to the client's mental and physical condition.Health System Nurse Case Manager I:
Pay Range: $48.4236 to $74.9477 per hourEducation: Successful completion of the coursework required to obtain a valid license to practice as a registered nurse in the State of California.Experience: Three years of full-time experience as a registered nurse in an acute care facility, mental health facility, or community health agency with references and evaluations to show appropriate skill level. One year of experience in Case Management and/or Utilization Review is preferred. (Possession of a Master's degree from an accredited college or university in nursing may be considered in lieu of one year of experience.)Health System Nurse Case Manager II:
Pay Range: $53.0510 to $79.9602 per hourOther Requirements for Both Levels I and II:
License: Must maintain a current, valid license to practice as a Registered Nurse in the State of California.Certification: Must maintain a valid Basic Life Support (BLS) certificate issued by the American Heart Association for professional healthcare providers.Possession of a valid California Driver's License may be required.What’s Next?
Open to All ApplicantsThis recruitment is open to all applicants.Applicants who are current County of Riverside employees and/or current employees of the RUHS Division may be considered before other applicants depending on the volume of applications received.Application Period:
BASED ON THE NUMBER OF APPLICATIONS RECEIVED, THIS POSTING MAY CLOSE WITHOUT NOTICE.Applications received prior to the closing date will be considered based on the information submitted. Changes or alterations cannot be accepted. All applicants must submit a complete application by the closing date of this recruitment. No late applications will be permitted.Qualified applicants may be considered for future vacancies throughout the County.Upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account. If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services (NACES) or Association of International Credential Evaluators, Inc. (AICE).For more information regarding this position, please contact the recruiter, Lisette Jimenez via email at
lijimenez@rivco.org .
#J-18808-Ljbffr