Description
Job Description
UC Title: Mgr, Case Management FVR
Position Number: 41087592
Reports to: Dir, Case Management LOM
Working Title: Mgr, Case Management FVR
Cost Center: Case Management-LOM (423750)
Bargaining Unit: No Bargaining Unit
FLSA: Exempt
Date Created: 5/03/2024
Job Code: 009504
Hours: 40
Shift: Not Applicable
FTE: 1
Position Summary:
The individual in this position supports the Director of Case Management (DCM) in the hospital utilization performance improvement and operational management of the Case Management Department in order to promote effective utilization of hospital resources, ensure process support appropriate reimbursement for services rendered, support efficient patient throughput, and ensure compliance with all state and federal regulations related to case management services. The individual's responsibilities include the following activities: a) support the management of department operations to assure effective throughput and reimbursement for service provided, b) supports DCM in the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement, c) ensure medical necessity review processes are completed accurately and in compliance with CMS regulations and Tenet policy, d) ensure timely and effective patient transition and planning to support efficient patient throughput, e) implement and monitor processes to prevent payer disputes, f) collaborates with physicians, office staff, and ancillary departments, g) ensure compliance with state and federal regulations and TJC accreditation standards, h) lead complex case review in DCM's absences, i) assist DCM with onboarding of new employees and education of staff, j) support coaching and performance management of staff with DCM, and k) other duties as assigned.
Total Compensation
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:
Compensation practices (https://www.hr.uci.edu/partnership/totalrewards/compensation.php) and
Benefits (https://careersucirvine.ttcportals.com/pages/benefits).
Required Qualifications:
CA Licensed Registered Nurse. 3 Years Case Management/Utilization Review experience in acute care. Supervisory experience. Skills required include excellent organizational skills, excellent verbal and written communication skills, demonstrated problem solving skills, and computer literacy.
Ability to establish and maintain effective working relationships across the Health System
Ability to maintain a work pace appropriate to the workload
Must demonstrate customer service skills appropriate to the job
Excellent written and verbal communication skills in English
Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
Preferred Qualifications:
Bachelor's degree preferred. CCM or ACM Certification
Knowledge of University and medical center organizations, policies, procedures and forms
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
- Vaccination Policies
- 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.
- California Child Abuse and Neglect Reporting Act
- E-Verify
- Pre-Placement Health Evaluation
Details of each policy may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php
Closing Statement:
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 eec@uci.edu or at (949) 824-0500, Monday – Friday from 8:30 a.m. – 5:00 p.m.
Physical, Mental, & Environmental Demands
To comply with the Rehabilitation Act of 1973 the essential physical, mental and environmental requirements for this job are listed below. These are requirements normally expected to perform regular job duties. Incumbent must be able to successfully perform all of the functions of the job with or without reasonable accommodation.
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