CASE MANAGER - SYSTEMWIDE UR - Clinical Revenue Recovery - Full Time - Day in San Diego, CA at Scripps Corporate Offices

Date Posted: 2/18/2018

Job Snapshot

Job Description

Responsible for review and management of assigned cases for utilization review and system reimbursement. Participates in the coordination and completion of regulatory audits. Utilizes critical thinking, interpersonal and technical skills in data collection and denial management.

Job Requirements

Required Education/Experience/Specialized Skills: Graduate of an accredited RN Program. Three or more years recent clinical experience in a hospital setting. Previous Utilization Management, Audit, Appeals, Discharge Planning, or Case Management experience is preferred. Knowledge of InterQual and Milliman criteria. Understanding of financial reimbursements, state and federal insurance programs, and the revenue cycle is strongly recommended. Ability to manage multiple tasks within regulatory agency time frames required. Strong computer skills including spreadsheet and data base management.

Required Certification/Registration: Current RN license issued by the state of California.

Preferred Education/Experience/Specialized Skills/Certification: BSN, Certification in UR/UM or CM.

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.