Case Manager - Utilization Review
Overview: St. Francis Medical Center is one of the leading comprehensive healthcare institutions serving Southeast Los Angeles. St. Francis is dedicated to providing vital healthcare services for the 700,000 adults and 300,000 children who count on the hospital for high quality and compassionate medical care. St. Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Surgical, Orthopedics, Maternal-Child Health, Behavioral Health and Emergency and Trauma Care. In addition, the hospital offers a broad array of education and outreach programs that advance community health. St. Francis Medical Center is a Certified Primary Stroke Center, Approved STEMI Receiving Center for Los Angeles County and designated Baby-Friendly healthcare facility by Baby-Friendly USA. Please visit www.stfrancismedicalcenter.comfor more information. Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Why Prime Healthcare? St. Francis Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. Click Here to Schedule or Text: 909-679-1983 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 401K retirement plan Outstanding Medical Dental Vision coverage Tuition reimbursement 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. Company is an equal opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local law. The company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf 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 insure 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 1. Starting April 1 2015. Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license. 2. Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred. 3. Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred. 4. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience and knowledge in basic to intermediate computer skills. 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 $45.83 to $61.61. 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. Apply Job!