UCSD Layoff from Career Appointment: Apply by 10/9/2019 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.
Special Selection Applicants: Apply by 10/21/2019. Eligible Special Selection clients should contact their Disability Counselor for assistance.
UC San Diego Health was recently recognized as sixth among the top academic medical centers in the U.S. for excellence in delivering high-quality care. The ranking is based on the Vizient Quality and Accountability dashboard which measures safety, mortality, clinical effectiveness, efficiency and patient centeredness.
Dedicated Nurse Care Manager assigned only to conduct Utilization Review. Under general supervision, the UR CM will conduct daily admission and continued stay reviews applying national screening guidelines and medical necessity criteria in order to determine necessity for admission and continued stay. Incumbent demonstrates knowledge of different payor classifications, rules and criteria for authorization. Incumbent works with a licensed support liaison in order to facilitate concurrent reviews, peer discussion, second level reviews and appeals. Completes discussions regarding admission status, level of care and continued stay criteria with physician advisor, unit based case managers and treating physicians and external providers. Utilizes computer and word processing skills with familiarity in using criteria guidelines and electronic medical records. Performs other related CM duties, as required.
While not required, a cover letter is highly recommended when applying to this position.
Must be a graduate from an accredited school of Nursing.
Registered Nurse (RN) license issued by the State of California.
BART or BLS at time of hire with commitment to get BART within six months of hire date.
Background in case management, utilization review, and discharge planning, homecare or managed care
Knowledge of payer industry, resource management, reimbursement, and evidence-based clinical practice is essential.
UC San Diego is an academic powerhouse and economic engine, recognized as one of the top 8 public universities by U.S. News and World Report. Innovation is central to who we are and what we do. Here, students learn that knowledge isn't just acquired in the classroom - life is their laboratory. UC San Diego's rich academic portfolio includes six undergraduate colleges, five academic divisions and five graduate and professional schools. The university's award-winning scholars are experts at the forefront of their fields with an impressive track record for achieving scientific, medical and technological breakthroughs.