Your Role on the Team

Position Summary:
Incumbent is responsible for implementing the utilization management process for patients admitted to the hospital. Monitors and coordinates resource utilization throughout the health system and evaluates services provided. Performs the appropriate utilization review functions utilizing medical staff-approved decision support criteria (InterQual Intensity of Service, Severity of Illness criteria). Analyzes and identifies utilization patterns and trends and participates in the collection and analysis of data for the denial process as well as special studies, projects, audits, or routine utilization monitoring activities. Ensures clinical information in the medical record is clear and complete reflecting the patient's true severity of illness through interfacing with physicians to improve the overall quality of the clinical documentation.

What It Takes to be Successful

Required Qualifications:

Must possess the skill, knowledge, and ability essential to the successful performance of assigned duties

Must possess complete understanding of acuity levels for specific patient population

Must demonstrate customer service skills appropriate to the job

Minimum 5 years of clinical experience and 1 year of previous Case Management experience or a UCI employee who meets the clinical requirements and has a BSN.

Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop-down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job

Familiarity of Joint Commission, CMS, CDPH and CCS requirements

Excellent written and verbal communication skills in English

Current RN License

Computer literacy and proficiency

All external candidates must have a Bachelor of Science in Nursing

Ability to manage multiple concurrent projects and maintain a work pace appropriate to the workload

Ability to establish and maintain effective working relationships across the Health System

Preferred Qualifications:

Knowledge of University policies and procedures

Knowledge of California Children's Services benefits authorization process (CCS)

CCM, ACM

Bilingual skills

Licenses and Certifications:

RN

BLS

Education:

Total Rewards

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.

Conditions of Employment:

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:

• Background Check and Live Scan
• Employment Misconduct*
• Legal Right to Work in the United States
• Vaccination Policies
• Smoking and Tobacco Policy
• Drug Free Environment

*Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.

• California Child Abuse and Neglect Reporting Act
• E-Verify
• Pre-Placement Health Evaluation

Details of each policy may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php

Consideration for Work Authorization Sponsorship

Must be able to provide proof of work authorization