UC Davis Health System

Case Manager- UM/Managed Care (43945208)
Location: Sacramento, California - United States
Posted: 12/5/2017

Case Manager- UM/Managed Care

The Managed Care Utilization Management/Case Management Department includes the combined responsibilities of Utilization Management and Case Management for the HMO capitated membership assigned to the UC Davis Medical Group Responsibilities The Case Manager performs both functions of Utilization Management and Case Management. The Case Manager's work is performed independently. This position will receive direction concerning the overall goals and objectives of the Department and will participate in actions to achieve those goals Qualifications --Current California RN License. --BSN for external candidates and per diem transfers. --Extensive (at least three years) recent experience in an acute care setting. --Extensive knowledge of and experience with HMO Health Plan or Medical Group/IPA Utilization Management/Case Management or acute care facility discharge planning functions. --Extensive, broad-based clinical experience. --Experience in identifying and analyzing care/service needs for case managed patients. --Skills to perform in-depth chart analysis to provide accurate information in a concise, informative manner. --Skills in assessing the appropriateness and medical necessity for acute and Skilled Nursing Facility (SNF) admissions and continued stays. --Clinical skills and knowledge. --Knowledge of care/services provided in differing levels of care, i.e., ambulatory and institutional settings. --Knowledge of medical and nursing treatment plans. SPECIAL REQUIREMENT --Proof of licensure and education required at time of hire. --Occasional overtime and flexible work hours to meet operational purposes. --THIS POSITION MAY BE SUBJECT TO A CRIMINAL BACKGROUND INVESTIGATION, DRUG SCREEN, LIVE SCAN FINGERPRINTING, MEDICAL EVALUATION CLEARANCE, AND FUNCTIONAL CAPACITY ASSESSMENT

Additional Requirments / Information

Job Capacity:Employee (full-time)
Minimum Education Level:See Job Description
Visa Sponsorship: No
Related Industries:Nursing, Case Management

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