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health system nurse case manager i/ii - , CA, United States - County of Riverside, CA
Description
ABOUT THE POSITION
The County of Riverside - Riverside University Health System-Medical Center is seeking highly skilled and experienced Registered Nurses to join our team as a Health System Nurse Case Manager with the UR Case Management Department.
The most competitive candidates will have three years of full time experience as a Registered Nurse in an acute care setting.
Preferred Qualifications:
Work schedule:
EXAMPLES OF ESSENTIAL DUTIES
Within the full scope of the Nursing Practice Act, assess, plan, organize, and provide nursing, case management and utilization review services for patients.
Evaluate healthcare services of requesting physicians based on the appropriateness of the service and the level of care at which service would be delivered; act as a neutral advocate for patients; act as a resource to physicians for adequate medical record documentation, appropriateness of facility services as they relate to diagnoses, and options for post-discharge care.
Perform utilization review in concert with the utilization review physician and make recommendations to approve, delay, modify, or deny treatment.
Coordinate and monitor patients through the hospitalization process utilizing physicians, nurses, other healthcare providers, and third party payors to maintain quality care and fiscal responsibility; monitor completion of healthcare services to avoid delays in care and discharge; facilitate third party reimbursement approval and/or authorization.
As directed, coordinate community-based medical post-discharge activities for patients; record and report significant changes in condition and general progress of patient, and provide preemptive recommendations.
Counsel and advise patients regarding proper healthcare methods; review the post-hospital care plan with the patient/family; follow plan through to discharge.
May provide orientation and training to new staff; may identify staff training needs.
Participate in quality assurance and performance improvement reviews.
Participate in hospital utilization review committee activities.
May testify in court as to the client's mental and physical condition.
MINIMUM QUALIFICATIONS
Health System Nurse Case Manager I:
Pay Range:
$ to $ per hour
Education:
Successful completion of the coursework required to obtain a valid license to practice as a registered nurse in the State of California.
Experience:
Three years of full time experience as a registered nurse in an acute care facility, mental health facility, or community health agency with references and evaluations to show appropriate skill level.
One year of experience in Case Management and/or Utilization Review is preferred. (Possession of a Master's degree from an accredited college or university in nursing may be considered in lieu of one year of experience.)Knowledge of:
Case management and utilization review principles and practices; payor source documentation requirements and governmental regulations affecting reimbursement, managed care, and healthcare issues and standards; application of the nursing process; full range of registered nurse duties and responsibilities; community resources available to provide patient care and follow-up; federal, state, and local laws and regulations governing professional aspects of nursing; principles and methods of supervision and training; problem solving techniques.
Ability to:
Plan, organize, supervise, and evaluate nursing services on specific unit(s); communicate effectively; positively manage change and conflict; interpret licensure and accreditation standards; analyze and draft department policies and procedures; apply productive problem solving skills; write clear and concise reports; perform registered nurse or public health nurse responsibilities according to the State of California Nursing Practice Act; implement the nursing process.
Health System Nurse Case Manager II:
Pay Range:
$ to $ per hour
OPTION I
Education:
Graduation from an accredited college or university with an Associate's degree in nursing.
Experience:
Five years of full-time registered nurse experience in a managed care or acute care setting that includes a minimum of one year experience in Case Management and Utilization Review.
OPTION II
Education:
Graduation from an accredited college or university with a Bachelor's degree in nursing.
Experience:
Three years of full-time registered nurse experience in a managed care or acute care setting that included experience in Case Management and Utilization Review.
OPTION III
Education:
Graduation from an accredited college or university with a Master's degree in nursing.
Experience:
Two years of full-time registered nurse experience in a managed care setting that included experience in Case Management and Utilization Review.
Knowledge of:
Case management and utilization review principles and practices; payor source documentation requirements and governmental regulations affecting reimbursement, managed care, and healthcare issues and standards; application of the nursing process; full range of registered nurse duties and responsibilities; community resources available to provide patient care and follow-up; federal, state, and local laws and regulations governing professional aspects of nursing; principles and methods of supervision and training; problem solving techniques.
Ability to:
Plan, organize, supervise, and evaluate nursing services on specific unit(s); communicate effectively; positively manage change and conflict; interpret licensure and accreditation standards; analyze and draft department policies and procedures; apply productive problem solving skills; write clear and concise reports; perform registered nurse or public health nurse responsibilities according to the State of California Nursing Practice Act; implement the nursing process.
Other Requirements for Both Levels I and II:
License:
Must maintain a current, valid license to practice as a Registered Nurse in the State of California.
Certification:
Must maintain a valid Basic Life Support (BLS) certificate issued by the American Heart Association for professional healthcare providers.
Possession of a valid California Driver's License may be required.Additional Requirement for Level II:
Certification:
Must maintain a current and valid Case Manager Certification.
SUPPLEMENTAL INFORMATION
Veterans' Preference:
The County has a Veteran's Preference Policy.
Upload a copy of your (or your spouse's) Member-4 Form DD-214 indicating dates of service, and a copy of your spouse's letter of disability (if applicable) with your application.
For privacy reasons, it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans' preference. See the policyhere.What's Next?
Open to All Applicants
This recruitment is open to all applicants.
Applicants who are current County of Riverside employees and/or current employees of the RUHS Division may be considered before other applicants depending on the volume of applications received.
BASED ON THE NUMBER OF APPLICATIONS RECEIVED, THIS POSTING MAY CLOSE WITHOUT NOTICE.
Applications received prior to the closing date will be considered based on the information submitted. Changes or alterations cannot be accepted. All applicants must submit a complete application by the closing date of this recruitment. No late applications will be permitted.
Include relevant work experience details on resume and/or application.
Applicants who fail to provide information demonstrating they possess the position requirements may not be considered further in the application process.
Qualified applicants may be considered for future vacancies throughout the County.
Upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account.
If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services (NACES) or Association of International Credential Evaluators, Inc.
(AICE).For more information regarding this position, please contact the recruiter, Lisette Jimenez via email at
