Description

American Traveler is hiring an experienced RN Case Manager for a Utilization Management Case Manager position requiring a CA RN license, acute care case management experience, and proficiency with Epic and InterQual/Milliman criteria.

Details

• Acute hospital setting with additional coverage scope including long-term acute care, rehab, and skilled nursing environments
• Case Management/Utilization Management unit with an average daily census of 30 patients and approximately 18 visits per day
• Adult patient population
• Monday through Friday schedule, 5x8 shifts (07:30–16:00), with weekends off
• Floating is required for this position
• No on-call responsibilities
• Block scheduling type
• EMR: Epic (experience required)

Requirements

• Active CA RN license in good standing required
• Active BLS certification required
• Certification in Case Management (CCM) preferred
• Minimum of an ADN required; BSN preferred
• Minimum 2 years of direct patient care experience in an acute care setting required
• Previous experience as a case manager in an acute care setting strongly preferred
• Must be actively functioning as an RN Case Manager with hands-on inpatient care coordination, discharge planning, and post-acute clinical payer authorization experience
• Proficiency with InterQual and Milliman clinical criteria required
• Working knowledge of utilization review functions including admission criteria, concurrent review, continued stay reviews, appeals and denials, medical necessity determinations, and retrospective review
• Familiarity with regulatory frameworks including CMS, DRG, ICD-10, CPT coding, HIPAA, The Joint Commission, HEDIS, NCQA, OSHA, and Workers' Compensation required

Additional Information

• Responsibilities include utilization management, quality assurance, and discharge planning for assigned patients within the health system
• Role requires strong independent decision-making, organizational and analytical skills, and the ability to leverage all continuum of care options
• Effective written and oral communication regarding case management functions is essential to this role
• First-time travelers will not be considered for this position
• All time off requests must be submitted at the time of initial consideration
• Note: Santa Barbara is a high cost-of-living area — candidates are encouraged to research local living costs before applying