Case Manager (CASE MGR NEX)

Job Summary #CA-FT The Case Manager performs utilization review for inpatient UC Davis capitated patient, patients admitted to external hospitals and review appropriateness of outpatient services (prior –authorizations).
The Case Manager’s work is performed independently.
The Case Manager will receive direction concerning the overall goals and objectives of the department and will participate in action to achieve those goals.
Apply By Date (February 18, 2024 at 11:59pm); Interviews and recruiting process may occur at any time.
Minimum Qualifications Valid California Registered Nurse License without restriction Graduation from an accredited School of Nursing, possession of current California RN License.
BSN required for external candidates and per diem conversions.
Minimum 1-3 years knowledge and experience with medical necessity reviews using an evidence-based criteria such as, Milliman or InterQual or health plan medical policies.
Minimum of three (3) years recent experience in an acute care setting.
Experience in identifying and analyzing care/service needs for case managed patients.
Skills to perform in-depth chart analysis to provide accurate information in a concise, informative manner.
Knowledge of care/services provided in differing levels of care, i.
e.
, ambulatory and institutional settings.
Knowledge of medical and nursing treatment plans.
Skill in assessing the appropriateness and medical necessity for acute and SNF admissions and continued stays.
Clinical skills and knowledge to assess type and amount of home health care necessary to meet patients’ needs in the home setting.
Analytical skills to identify and obtain pertinent data from multiple sources, accord each piece of information the appropriate weight and consideration, and reach the appropriate logical conclusions/recommendations.
Effective time management skills to accommodate special projects, deadlines, and priorities.
Preferred Qualifications Broad-based clinical experience as a Registered Nurse in multiple clinical settings.
Knowledge and experience with HMO Health Plan or Medical Group/IPA Utilization Management/Case Management or acute care facility discharge planning functions UR and DCP experience Department Description The Managed Care Utilization Management includes the responsibilities of Utilization Management for the HMO capitated membership assigned to the UC Davis Medical Group.
The Department interacts daily with UC Davis Health System physicians and staff, including Clinical Case Management, and Ambulatory Case Management, Provider Relations, Health System Contracts, UC Davis Primary Care Network medical directors and staff and Managed Care Operations Department (Claims and Member Services).
The Utilization Management (UM) function of the department insures services/care rendered to UC Davis Medical Group capitated members are medically necessary/appropriate and in conformance clinically with the benefits of the member’s health plan coverage.
Position Information Salary or Pay Range: $65.
90-$96.
53 Salary Frequency: Hourly Salary Grade: HX-105 Payroll Title: (CASE MGR NEX) Number of Positions: 2 Appointment Type: Career Percentage of Time: 100% Shift Hours: 8am-5pm Location: 10850 White Rock Road, Rancho Cordova Union Representation: Yes Benefits Eligible: Yes Hybrid/Remote/On-Site: On-site transition to Hybrid after 6 months (1 to 2 days per month onsite/office) This is not an H1-B opportunity.
Benefits Outstanding benefits and perks are among the many rewards of working for the University of California.
UC Davis Health offers a full range of benefits, resources and programs to help you bring your best self to work, as well as to help you and your family achieve your health, wellness, financial and career goals.
Learn more about the benefits below and eligibility rules by visiting our handy Benefits Summary and our Benefits Page If you are represented by a union, benefits are negotiated between the University of California (UC) and your union and finalized in a contract.
Read your bargaining unit's employment contract, stay abreast of current negotiations and learn about collective bargaining at UC: https://ucnet.
universityofcalifornia.
edu/labor/bargaining-units/index.
html High quality and low-cost medical plans to choose from to fit your family’s needs UC pays for Dental and Vision insurance premiums for you and your family Extensive leave benefits including Maternity, Paternity, Family & Medical Leave Paid Holidays annually as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement.
Paid Time Off/Vacation/Sick Time as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement.
Paid time off for professional development as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement.
Continuing Education (CE) allowance and Education Reimbursement Program as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement.
Access to free professional development courses and learning opportunities for personal and professional growth Wellness and on-site Employee Assistance Program including access to free mental health services Supplemental insurance offered including additional life, disability, short/long term disability, pet insurance and legal coverage Public Service Loan Forgiveness (PSFL) Qualified Employer & Student Loan Repayment Assistant for qualified roles Retirement benefit options for eligible roles including Pension and other Retirement Saving Plans.
More information on our retirement benefits can be found here UC Davis cares about building a community, which is why we provide resources to enhance diversity, equity and inclusion as well as Employee Resource Groups (ERGs) to support our staff Physical Demands and Work Environment Occassional overtime and/or flexible hours may be necessary as determined by the department.
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Special Requirements This position is a critical position and subject to a background check and drug screen.
Employment is contingent upon successful completion of background investigation including criminal history, identity checks and drug screen.
As a condition of employment, you will be required to comply with the University of California Policy on Vaccination Programs, as may be amended or revised from time to time.
Federal, state, or local public health directives may impose additional requirements.
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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC nondiscrimination policy.
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Studies have shown that some people may not apply to jobs unless they meet every single qualification.
Each unique role at UC Davis has a set of requirements and you could be perfect for this role, or you could be perfect for the next role! Don’t meet all the requirements? We still encourage you to apply! #YouBelongHere