St Francis Medical Center

RN Case Manager - Utilization Review

St Francis Medical Center$98K — $132K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Minimum 5 years of nursing experience post-graduation from an accredited school
  • At least 1 year in case management or nursing management
  • Basic to intermediate computer skills required
  • Preferred 5 years of acute care nursing experience
  • CCM certification desirable within one year
  • Familiarity with Milliman and InterQual Criteria is a plus
  • Current BCLS certification preferred

Responsibilities

  • Manage quality and resources for admitted patients throughout their care continuum
  • Promote cost containment while ensuring effective delivery of healthcare
  • Lead integration efforts among healthcare providers for seamless patient care
  • Conduct comprehensive reviews of medical records for necessity and service intensity
  • Facilitate achievement of quality clinical outcomes and cost-effectiveness

Benefits

  • Comprehensive benefits package including health, dental, and vision coverage
  • 401K retirement plan
  • Paid time off
  • Tuition reimbursement
  • Voluntary benefit options available
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

    St. Francis 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. Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time. The current compensation range for this role is $47.20 to $63.45. 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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