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UTILIZATION REVIEW CASE MGR in San Diego, CA at Scripps Mercy Hospital San Diego

Date Posted: 6/5/2019

Job Snapshot

  • Employee Type:
  • Location:
    4077 Fifth Avenue
    San Diego, CA
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  • Date Posted:
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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.
As a Utilization Review Case Manager Inpatient RN working at Scripps Health Mercy San Diego, 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. 
You will be responsible for conducting admission, concurrent, and retrospective case review for all payor sources. You'll review all admissions for appropriate level of care consulting with the physicians regarding appropriate level of care orders. Be responsible for concurrent reviews to support continued medical necessity and confers with physician on changes in level of care including compliance with CMS regulations. You'll coordinate communications between attending physician and insurance Medical Director. Play an integral role in supporting the development, utilization, implantation, and monitoring of utilization review/performance improvement projects.
This is a full-time (80 hours per pay period), 10.25-hour DAY shift position.  This position is located at Scripps Mercy Hospital San Diego.

Job Requirements

Required Experience/Specialized Skills:  
  • 3 to 5 years Clinical experience.
Required Certification/Registration: 
  • Current California RN License
Required Education/Course(s)/Training:
  • Completion of certification in Utilization Management within 1 year of hire.
  • Knowledge of Milliman and/or Mckesson InterQual Guidelines.
Preferred Qualifications:
  • Bachelor of Science in Nursing (BSN) preferred.
  • Previous experience in utilization management and discharge planning preferred.
  • Knowledge and experience using MS Office (Word and Outlook), Allscripts (ECIN), and EPIC preferred

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.