Health System Nurse Case Manager I/II - Moreno Valley, CA

ABOUT THE POSITION · The County of Riverside - Riverside University Health System-Medical Center is seeking highly skilled and experienced Registered Nurse to join our team as a Health System Nurse Case Manager with the UR Case Management Department located in Moreno Valley. · ...

Job description

ABOUT THE POSITION

The County of Riverside - Riverside University Health System-Medical Center is seeking highly skilled and experienced Registered Nurse to join our team as a Health System Nurse Case Manager with the UR Case Management Department located in Moreno Valley.

The most competitive candidates for this role will have a strong background in hospital case management and utilization review management. Experience with or a thorough knowledge of InterQual criteria is highly preferred, as it will enhance the candidate's ability to evaluate and coordinate care effectively.

Highly Preferred Qualifications:

• Acute Hospital Case Management and Utilization Review experience is highly preferred.
• Case Manager Certification (CCM)
• Interqual experience/Interqual certification a plus
• Knowledge in electronic health record systems (EPIC)
• Knowledge of healthcare regulations and reimbursement processes.

Work Schedule:

9/80, Monday to Friday, with every other Friday off

Hours: 8:00 am to 5:30 pm

Health System Nurse Case Manager I: $ $ per hour

Health System Nurse Case Manager II: $ $ per hour

Meet the Team

At Riverside University Health System Medical Center, nursing is more than a job, it's an opportunity to make a real difference in a vibrant and diverse community. Nationally recognized for its forward-thinking and innovative approach to patient care, RUHS Medical Center is also a proud teaching hospital and one of the top employers in the region.

Our 439-bed facility is a designated Level I Trauma Center, Primary Stroke Center, and home to the region's only Pediatric Intensive Care Unit (PICU). Here, you'll gain valuable experience across a wide range of specialties, including trauma care, stroke, pediatrics, and critical care.

We are committed to your professional growth, offering continuous education, training, and career development programs in a collaborative, supportive, and rewarding environment. Whether you're an experienced nurse or just starting your career, RUHS Medical Center provides unparalleled opportunities to learn, grow, and make a meaningful impact.

Could you see yourself making a difference here?

Discover more about RUHS Medical Center at

EXAMPLES OF ESSENTIAL DUTIES

• Within the full scope of the Nursing Practice Act, plan, implement, coordinate, monitor, and evaluate medical services; provide nursing case management, discharge planning and utilization review services to patients; act as department resource for medical inquiries, claim file reviews and utilization review.

• 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.

• Provide and coordinate community-based medical post-discharge activities for patients provide early medical management intervention for new patient illness/disease, consulting on medical only files and utilization review on all requests for medical treatment; review the post-hospital care plan with the patient/family; follow plan through to discharge.

• 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 to approve, delay, modify, or deny treatment.

• Perform medical reviews on patient services claims and provide recommendations, which are preemptive and focused on moving the patient along the healing continuum.

• Apply clinical expertise as a resource to case management staff, physicians, nurses, and other healthcare providers to identify the best results while coordinating the appropriate resource utilization; identify and manage patient problems to eliminate duplication and fragmentation of healthcare services.

• Counsel and advise patients regarding proper healthcare methods.

• Assist in the development of policies and procedures, standards of care and practice, and in the monitoring of those standards to ensure regulatory compliance, as required by the Joint Commission, Centers for Medicare and Medicaid Services, and the State of California Department of Health Care Services.

• Prepare and maintain concise, complete records and reports, including post-discharge documentation.

• Promote collaboration among hospital interdisciplinary departments, programs, and physicians; represent the Case Management and Utilization Review Department when needed in hospital committee meetings.

• Provide orientation and training to new staff; identify staff training needs.

• Participate in quality assurance and performance improvement reviews.

• May testify in court as to the client's mental and physical condition.

MINIMUM QUALIFICATIONS

Health System Nurse Case Manager I

Salary Range: $50.3605/hour to $77.9456/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. Additional qualifying experience as a full-time Licensed Vocational Nurse (LVN) may substitute for the required Registered Nurse experience up to three years on the basis of two years of full-time experience as an LVN equaling one year of full-time Registered Nurse experience. Licensed Vocational Nurse experience must be in an acute care setting within a hospital. One year of experience in Case Management and/or Utilization Review is preferred. (A bachelor's degree from an accredited college or university in nursing may substitute for one year of the required 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; current principles, techniques and procedures used in professional nursing; medical terminology and patient care routine appropriate to clinical setting; medical instruments and equipment; the uses and effects of medicines and narcotics; community resources available to provide patient care and follow-up; federal, state and local laws and regulations governing professional aspects of nursing.

Ability to: Perform the full range of nursing duties and responsibilities in a patient care setting; plan and organize nursing plans for patients; prepare and maintain concise, complete records and reports; establish and maintain effective working relationships with physicians, patients and fellow employees; make recommendations regarding continued stay necessity and appropriateness of the level of the delivery of care; identify discharge needs; use ancillary services and discharge plans; assist in the instruction of entry level nurses and ancillary personnel; keep abreast of developments in area of nursing specialization.

Health System Nurse Case Manager II:

Salary Range: $55.1731/hour to $83.1586/hour

Option I:

Education: Successful completion of the coursework required to obtain a valid license to practice as a Registered Nurse in the State of California.

Experience: Four years of full-time experience as a Registered Nurse in a managed care, acute care facility, mental health facility, or community health agency setting that includes a minimum of one year of 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 experience as a Registered Nurse in a managed care, acute care facility, mental health facility, or community health agency 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 experience as a Registered Nurse in a managed care, acute care facility, mental health facility, or community health agency setting that included experience in Case Management and Utilization Review.

All Options:

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 Level I and II:

License: Must maintain a current, valid license to practice as a Registered Nurse in the State of California.

A valid Basic Life Support (BLS) certification issued by the American Heart Association.

Possession of a valid California Driver's License may be required.

Additional Requirement for Health System Nurse Case Manager II:

Certificate: Must maintain a current and valid Case Manager Certificate.

SUPPLEMENTAL INFORMATION

Application Status

How to confirm your application was received or check on the status of your application, log-in to , click on your name in the upper right corner, and click on "Applications & Status."

Sign Up for Job Alerts

Go to www.RC-, click on "Careers," click on "County Job Openings," and click on "Subscribe to Job Alerts" icon.

For questions regarding this recruitment,

Please contact Lisette Jimenez at or Please allow 1-2 business days for a response to general inquiries.

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APPLICATION INFORMATION

Veteran's Preference

The County has a Veterans Preference Policy applicable to new hires. To qualify, 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. The Veterans Preference Policy, C-3 is available here:

Reasonable Accommodations

The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation, please visit the Disability Access Office web page located at: https://rc-

Proof of Education

If using education to qualify or when requested by the recruiter, upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.

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).

Work Authorization Requirement

Applicants must be legally authorized to work in the United States at the time of application. The County of Riverside does not participate in visa sponsorship programs, including H1-B visas, and will not provide sponsorship for any employment-based visas.

Equal Opportunity Employer

The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition (cancer and genetic characteristics), genetic information, or denial of medical and family care leave, or any other non-job-related factors.

Pre-Employment

All employment offers are contingent upon successful completion of pre-employment requirements including a criminal background investigation, which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A pre-employment physical examination and background check may be required.

Probationary Period

As an Approved Local Merit System, all County of Riverside employees, except those serving "At Will," are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding, County Resolution, or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.

General Information

Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies.

Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume, as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.

Please read and follow any special application instructions on this posting. Click the 'Apply' link located on this page to submit your application. For additional instructions on the application process, examinations, Veteran's preference, pre-employment accommodation or other employment questions, please refer to our web site,

If you are experiencing technical problems, you may contact the applicant support desk Monday through Friday, 6 am to 5 pm Pacific Time at or toll-free