RN - Case Manager - Utilization Review

For more than half a century, UCLA Health has provided the best in healthcare and the latest in medical technology to the people of Los Angeles and throughout the world. Comprised of Ronald Reagan UCLA Medical Center, UCLA Medical Center, Santa Monica, Resnick Neuropsychiatric Hospital at UCLA, Mattel Children's Hospital UCLA, and the UCLA Medical Group with its wide-reaching system of primary-care and specialty-care offices throughout the region.

* The Case Manager is responsible for utilizing advanced nursing skills in the assessment and planning of clinical care for an identified group of patients. * Collaborates with the Attending, Resident, and Intern medical staff as well as Resource Planning, Nursing, ancillary, professional, and technical staff to coordinate the delivery of high quality, individualized, cost-effective patient care. * Performs appropriate Utilization Review functions utilizing approved Intensity of Service, Severity of Illness criteria. * Coordinates utilization management and evaluates services provided. * Oversight responsibilities of the Resource Planner includes delegation and supervision of daily work assignments, education of the discharge planning process, and identification of barriers to discharge/transfers. * Concurrently intervenes to enhance patient quality outcomes where appropriate. * Brings support to the performance improvement process by comprehensive analysis of patterns and trends. * Acts as a consultant to the Care Coordination team, clinical team, and other departments.

* RN required; BSN highly preferred, MSN preferred. * Minimum of three years of acute hospital experience; or the equivalent of education and experience. * Recent experience in case management, utilization management, or discharge planning. * Team leading or management experience. * Self-directed, assertive and creative in problem solving, systems planning and patient care management in a high volume work environment. * Demonstrates resourcefulness, effective written and oral communication, diplomacy, organizational, and analytical skills (Required). * Ability to work effectively and collaboratively with interdisciplinary teams. * Basic working knowledge of a large University teaching hospital; its purpose and functions.