(RN) Prior Authorization UM Case Manager - Hybrid - 141189

UC San Diego Health is proud to be a four-time Magnet-designated organization and has now earned Magnet with Distinction from the American Nurses Credentialing Center (ANCC). Magnet is the gold standard for nursing excellence, achieved by only about 10% of hospitals worldwide. Magnet with Distinction is awarded to the highest-performing Magnet organizations, with only a select few earning this prestigious honor. This recognition reflects our commitment to transformational leadership, professional nursing excellence, innovation, exceptional patient outcomes, and an empowering practice environment where nurses thrive.

The Population Health Care Connections Hub consists of a team of RN with case management experience who perform telephonic outreach to high-risk patients to help prevent avoidable events. Most of these calls are for patients who discharge from an acute inpatient stay and /or it could be for internal provider referrals for our patients who may need additional help while at home. This role requires someone who has strong initiative, critical thinking skills, and previous case management experience. Previous experience with EPIC and Care Port a plus. Knowledge of community resources is critical to help patients with their care coordination needs. A strong understanding of payers, community resources, DME, HH, and skilled nursing facilities in the area is critical to being successful in this role

• Must be a graduate from an accredited school of Nursing.

• RN license issued by the State of California.

• Minimum two (2) years of recent RN experience in inpatient case management and recent ambulatory RN CM experience.

• Proven background in managing high-risk patients post-discharge. Strong preference for experience in telephonic outreach with high-risk patient populations and working with insurance companies.

• Proficiency in Information Systems and computer programs such as Word and Excel.

• Must possess excellent interpersonal and communication skills.

• Must be able to work within a team environment.

• BSN or Master's Degree.

• ACM and/or CCM certificate.

• Epic knowledge and experience.

• Must have access to high-speed internet when working remotely.
• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and a pre-employment physical.