Case Manager (RN) - Utilization Management
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Job overview
Prime Healthcare is hiring a Case Manager (RN) - Utilization Management. Join an award‑winning team of dedicated professionals committed to quality, compassion and community at San Dimas Community Hospital, a 101‑bed facility offering comprehensive services and recognized awards. The role involves managing patient admissions, ensuring cost‑effective care, and performing holistic reviews of medical records to achieve quality and clinical outcomes.
Key focus areas include Manage quality and resources for admitted patients across the care continuum., Promote cost containment and lead integration of health care providers for seamless care delivery., and Conduct holistic admission and concurrent reviews of medical records for necessity, intensity, and severity..
Successful candidates bring 5 Years Work Experience Post-Graduation Of Accredited School Of Nursing, Current State Registered Nurse License, and 1 Year Case Management Experience. Important skills include Computer Skills, Basic Computer Skills, Case Management, Discharge Planning, and Nursing Management. Preferred (not required): Milliman Criteria and InterQual Criteria.
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Full job description
Overview Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! San Dimas Community Hospital, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. San Dimas Community Hospital is a 101 bed facility located on a 13-acre campus in the heart of San Dimas. With a multidisciplinary team of experts and state of the art technology, we are committed to serving the community with personalized, high-quality care. We offer a full range of comprehensive services, including 24-hour emergency services, a family birth center, orthopedic surgery, advanced diagnostic services, cardiopulmonary and gastrointestinal services. San Dimas Community Hospital has received multiple awards including the "100 Top Hospitals," Women's Choice Award for America's Best Hospitals for Patient Safety, and Healthgrades awards, including the "Patient Safety Excellence Award." Learn more at sandimashospital.com.
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 EDUCATION, EXPERIENCE, TRAINING
Required Qualifications:
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Minimum 5 years' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license
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At least one year experience in case management, discharge planning or nursing management
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Experience and knowledge in basic to intermediate computer skills.
Preferred Qualifications:
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Five years of acute care nursing experience. preferred
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CCM or obtained within 1year
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Knowledge of Milliman Criteria and InterQual Criteria preferred.
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Current BCLS certificate, preferred Pay Transparency San Dimas Community Hospital offers competitive compensation and a reasonable compensation estimate for this role is $50.00. 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.
Employment Status Per Diem Shift Days Equal Employment Opportunity Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Privacy Notice Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf
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