UCSD Layoff from Career Appointment: Apply by 9/5/2017 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor. Eligible Disability Counseling and Consulting services (DCC) or Special Selection clients should contact their Vocational Rehabilitation Counselor for assistance.
This position will remain open until a successful candidate has been identified.
Reporting to the Medical Group Managed Care UM Manager, the ambulatory case manager is responsible for utilization management, patient care planning, and discharge planning. Interprets medical policy and benefit plan descriptions for covered and medically appropriate service authorization decisions, referencing available resources and guidelines as appropriate. Organizes and reviews referral cases with Medical Director as needed. Assists in monitoring referral patterns and makes recommendations to help improve access and quality of care. Reviews appropriateness of the primary and specialty care utilization process and acts as a clinical liaison between various oversight agencies and Managed Care. The case manager will be accountable for working with hospital and clinic patient care teams to assess and identify individual patient's needs, ensure timely initiation of care plans, and monitor patient progress relative to those plans. Will work closely with the interdisciplinary team, physicians, vendors, and health plans to enhance communication and improve quality and timeliness of care.
Must be a graduate from an accredited school of nursing.
RN License issued by the State of California.
A background in case management, utilization review, and discharge planning, homecare or managed care.
Proficiency in Information Systems and computer programs such as Word and Excel.
BSN or Master's Degree.
ACM and/or CCM certificate.
Three and half (3.5) years of acute care setting or clinical RN experience.
Two (2) or more years of utilization management experience.
Two (2) or more years of case management experience.
Managed Care UM/QI experience.
Midas, ECIN, Interqual and Milliman experience.
Must be able to work various hours and locations based on business needs.
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