St Francis Medical Center

Case Manager (RN) - Utilization Management

St Francis Medical Center$90K — $121K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Minimum 5 years post-graduation nursing experience with a current RN license
  • At least 1 year in case management, discharge planning, or nursing management
  • Basic to intermediate computer skills
  • Five years of acute care nursing experience preferred
  • CCM certification or obtained within 1 year preferred
  • Knowledge of Milliman and InterQual Criteria preferred
  • Current BCLS certification preferred

Responsibilities

  • Manage quality and resources for patients from admission onward
  • Promote cost containment and leadership in healthcare integration
  • Facilitate clinical and cost-effective outcomes
  • Conduct comprehensive medical record reviews for medical necessity
  • Ensure seamless delivery of care across healthcare providers

Benefits

  • Paid time off
  • 401K retirement plan
  • Medical, dental, and vision coverage
  • Tuition reimbursement
  • Flexible benefits options
Full Job Description
Responsibilities

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management.  Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care.  The methodology is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness. 

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required Qualifications:

  •  Minimum 5 years' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license
  • At least one year experience in case management, discharge planning or nursing management
  • Experience and knowledge in basic to intermediate computer skills.
  • Preferred Qualifications:

  • Five years of acute care nursing experience.  preferred
  • CCM or obtained within 1year
  • Knowledge of Milliman Criteria and InterQual Criteria preferred.
  • Current BCLS certificate, preferred
  • Pay Transparency

    Montclair Hospital Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $43.25 to $58.21 The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

    Employment StatusFull Time ShiftDays

    About St Francis Medical Center

    St. Francis Medical Center is a for-profit hospital in Lynwood, California, United States, owned by Prime Healthcare Services.
    Learn more about St Francis Medical Center

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