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CARE MANAGER - RN - Utilization Management in San Diego, CA at Scripps Health Plan Services -4S Ranch

Date Posted: 3/29/2019

Job Snapshot

Job Description

Change Lives, Starting with Yours 
 
At Scripps Health, you will experience the pride, support, respect that has been repeatedly recognized as one of the nation’s Top 100 Places to work.
 
You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates.  So if you’re open to change, go ahead and unlock your potential.

 
Truven Health Analytics named Scripps Health among the top five large health systems in the nation. Scripps was the only California health care system on the Truven Top 15 Health Systems list this year. This is the fifth time Scripps has received the honor.
 
As a Care Manage RN - Utilization Management (UM), you will be working with Scripps Health Plan Services, you’ll join a team of skilled medical professionals who provide superior health services in a caring environment. The Scripps Health team is dedicated to making a positive, measurable difference in the health of individuals in the communities we serve. 
 
 
The goal of the Care Manager RN - UM is to ensure delivery of optimal care while promoting fiscal responsibility. As Case Manager RN - UM, you will be utilizing for use objective data, evidence based screening tools, and care team referrals, the CM screens all patients in their assigned caseload to identify those patients who may have discharge needs; who may be at risk for an unplanned readmission within 30 days of acute care discharge; who have a high risk of mortality; who are medically complex and may have a prolonged LOS or who have payer issues. The CM completes a more comprehensive review of these targeted patients to develop a prioritized list of patients they will actively manage. The CM will coordinate with the health care team and the patient/family to address payer issues that impact care, and to develop a transition plan of care that includes a safe discharge plan and plan for follow up with care providers post discharge. The CM ensures that the patient/family agrees with and understands this transition plan and that the plan is implemented appropriately. Works in collaboration with utilization review nurse to ensure that reviews are completed timely.
 
Care Managers work closely with Physician Reviewers as well as non-clinical staff, and utilizes critical thinking, research and prioritizing skills. 
 
 
This is a Full Time position (80 hours in a pay period) located in 4S Ranch.
 
 

Job Requirements

Required Education/Experience/Specialized Skills:
  • 3 plus year's clinical experience.
Required Certification/Registration:
  • Current California RN License.
  • BLS for Health Care Provider.
Preferred Education/Experience/Specialized Skills/Certification:
  • Bachelor of Science in Nursing (BSN) highly desired.
  • Knowledge of Utilization management and prior authorization
  • Case Management and/or home care experience preferred.
  • Case management certification highly preferred.
  • Epic experience preferred.
 
*LI-SH1
Scripps Health is repeatedly named on the Fortune Magazine’s 100 Best Companies to work for, only San Diego-based company and Becker’s Healthcare Top Hospitals. Scripps Health offers a robust Total Rewards Program designed to compensate and motivate you throughout your career. Scripps Health Total Rewards Program includes a broad range of plans and programs including market competitive pay and performance incentives, health and wellness benefits, financial wellness benefits, work-life resources, learning and development opportunities, and rewards and recognition. Unlock your potential with Scripps Health today.


Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.