The Clinical Case Manager facilitates the integration and coordination of major aspects of utilization review and discharge planning for patient needs. This position requires a high level of clinical judgment, problem-solving skills, creativity, organizational and priority setting abilities, with excellent communication skills. Critical aspects of the role involve the assessment of clinical information to determine medical necessity for the identified level of care, assessment for appropriate services needed and resources available, and to facilitate the coordination of both internal and external health care providers to ensure optimal continuity of appropriate and cost-effective care. The Clinical Case Manager must effectively communicate with both internal and external providers and health plans, as well as community resources, to optimize medically necessary services. The Clinical Case Manager demonstrates the ability to fulfill responsibilities through clinical assessment, accurate and sound judgment, application of standardized criteria, and maintaining professional communication. The goal of coordinated discharge planning and utilization is achieved by actively directing and involving members of the multi-disciplinary team, outside providers, community resources, and third-party payors. The Clinical Case Manager accurately maintains and tracks pertinent data and statistics specific to area of practice, such as delays in service, patients who lack medical necessity for acute hospital admission, denials for continued stays, and other factors affecting appropriate utilization of health system resources
Apply By Date
(12/16/2023 at 11:59pm); Interviews and recruiting process may occur at any time
Possession of a current California RN license.
Minimum of 1-year recent experience in Case Management either Utilization Review and/or Discharge Planning
Graduation from an accredited school of nursing. BSN preferred.
Licensed RN with current working work experience in discharge planning, utilization review management
Knowledge of Medicare, MediCal, and HMO legislation; MI county contracts; third party payor contracts; Title XXII; the Joint Commission;
Demonstrated knowledge of how these programs/regulations affect the functions and role of the department.
Demonstrates the ability to incorporate them into departmental systems/processes. Knowledge of professional and ethical standards related to Clinical Case Management such as the Nursing Practice Ace, the Codes of Ethics from the American Nurses Association and the Standards of Practice &Scope of Services by the American Case Management Association.
Ability to read and comprehend English text and medical terminology; knowledge of medical and nursing treatment plans, levels of care, and area resources; skill in assessing the appropriateness of medical admissions and continued stay.
Skill to perform in-depth chart analysis to provide accurate information in a concise, informative manner, identify/analyze problems or issues related to areas of responsibility, developing an appropriate plan, and considering medical needs and resources available.
Ability to organize and direct varied health care team professionals in a manner that establishes a good rapport and professional working relationship.
Ability to work efficiently and independently, maintaining a calm manner while under pressure. Ability to organize work to accommodate special projects, deadlines and priorities; ability to be both flexible and adaptable in order to coordinate multiple variables and to respond to the need of a multi-faceted work area.
Possess clinical skills and knowledge base to assess and refer to discharge planning, possible needs for care necessary to meet patient's needs on discharge.
The purpose of the Clinical Case Manager is to support the interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Clinical Case Manager helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction). The Clinical Case Manager is accountable for a designated patient caseload and plans effectively to meet patient needs, manage the length of stay, and create a safe discharge plan. Facilitation of the collaborative management of patient care across the continuum, completing utilization review around LOC and authorization concerns, and intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement.
Salary or Pay Range: $63.98 - $93.72
Salary Frequency: Hourly
Number of Positions: Multiple
Appointment Type: Career
Percentage of Time: 100%
Shift Hours: 8:30am - 5:00pm
Location: Patient Support Services Building
Union Representation: Yes
Benefits Eligible: Yes
Outstanding benefits and perks are among the many rewards of working for the University of California. UC Davis Health offers a full range of benefits, resources and programs to help you bring your best self to work, as well as to help you and your family achieve your health, wellness, financial and career goals. Learn more about the benefits below and eligibility rules by visiting our handy Benefits Summary and our Benefits Page
This position is a critical position and subject to a background check and drug screen. Employment is contingent upon successful completion of background investigation including criminal history, identity checks and drug screen.
As a condition of employment, you will be required to comply with the University of California Policy on Vaccination Programs, as may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.
Diversity, Equity, Inclusion and Belonging
At UC Davis, we're solving life's most urgent challenges to bring a fuller, healthier, and more resilient world within reach. We grow from every challenge we take on and we don't just maintain - we improve. We recognize that creating an inclusive and intellectually vibrant organization means understanding and valuing both our individual differences and our common ground. The most comprehensive solutions come from the most diverse minds, and you belong here.
Because we want you to be seen, our recruiting process at UC Davis fosters authenticity, diversity, and inclusion. Studies have shown that some people may not apply to jobs unless they meet every single qualification. Each unique role at UC Davis has a set of requirements and you could be perfect for this role, or you could be perfect for the next role! Don't meet all the requirements? We still encourage you to apply! #YouBelongHere
The University of California 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.
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About University of California Davis Health System
UC Davis is the home of the Aggies — go-getters, change makers and problem solvers who make their mark at one of the top public universities in the United States. Since we first opened in 1908, we’ve been known for standout academics, sustainability and Aggie Pride as well as valuing the Northern California lifestyle. These themes are woven into our 100-plus-year history and our reputation for solving problems related to food, health, the environment and society.Our 5,300-acre campus is in the city of Davis, a vibrant college town of about 68,000 located in Yolo County. The state capital is 20 minutes away, and world-class destinations such as the San Francisco Bay Area, Lake Tahoe and the Napa Valley are within a two-hour drive.
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