Incumbent is responsible for implementing the utilization management process for patients admitted to the hospital. Monitors and coordinates resource utilization throughout the health system and evaluates services provided. Performs the appropriate utilization review functions utilizing medical staff-approved decision support criteria (InterQual Intensity of Service, Severity of Illness criteria). Analyzes and identifies utilization patterns and trends and participates in the collection and analysis of data for the denial process as well as special studies, projects, audits, or routine utilization monitoring activities. Ensures clinical information in the medical record is clear and complete reflecting the patient's true severity of illness through interfacing with physicians to improve the overall quality of the clinical documentation.
In addition to the salary range listed below, we offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our:
Annual RateMinimum$125,363.52 Midpoint$145,408.32 Maximum $165,432.24
Ability to manage multiple concurrent projects and maintain a work pace appropriate to the workload
Familiarity of Joint Commission, CMS, CDPH and CCS requirements
Ability to establish and maintain effective working relationships across the Health System
Must possess the skill, knowledge, and ability essential to the successful performance of assigned duties
Must demonstrate customer service skills appropriate to the job
Computer literacy and proficiency
Current RN License
Excellent written and verbal communication skills in English
Must possess complete understanding of acuity levels for specific patient population
Minimum 5 years of clinical experience and 1 year of previous Case Management experience or a UCI employee who meets the clinical requirements and has a BSN.
All external candidates must have a Bachelor of Science in Nursing
Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop-down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job
Knowledge of University policies and procedures
Knowledge of California Children's Services benefits authorization process (CCS)
Conditions of Employment:
The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:
Background Check and Live Scan
Legal Right to Work in the United States
Smoking and Tobacco Policy
Drug Free Environment
The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.
The University of California, Irvine is an Equal Opportunity/Affirmative Action Employer advancing inclusive excellence. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC nondiscrimination policy.
We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable and welcoming.
UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at firstname.lastname@example.org or at (949) 824-0500, Monday - Friday from 8:30 a.m. - 5:00 p.m.
Since 1965, the University of California, Irvine has combined the strengths of a major research university with the bounty of an incomparable Southern California location. UCI's unyielding commitment to rigorous academics, cutting-edge research, and leadership and character development makes the campus a driving force for innovation and discovery that serves our local, national and global communities.
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What About Legally Compelled Disclosure of Information?
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