(RN) High-Risk Case Manager - Population Health - 137853

UC San Diego Health is a Magnet designated organization, which is a prestigious recognition that applies to only 10% of all U.S. hospitals. Magnet is the "gold standard" for nursing excellence and is based on strengths in five key areas, which include transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovation and improvements and empirical outcomes. UC San Diego Health has held its Magnet status since 2011.

Under the general supervision of the UCSD at Home Program Manager, the RN Case Manager is responsible for our high risk patients and our adverse selected members in compliance with Health Plan and CMS regulations and delegation. Will work closely with our Medical Director and High Risk Program Manager. To be highly visible and engage in the Clinics, Clinic Managers, and Physician Leadership. The Case Manager applies clinical expertise and medical appropriateness criteria to resource utilization, discharge planning and follow up. Will attend regular onsite conferences with Case Managers, Clinic Staff, and other community partners as needed.

While not required, a cover letter is highly recommended when applying to this position.

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

• Registered Nurse (RN) license issued by the state of California.

• Understanding of Population Health and Value-Based Care models.

• Prior case management, utilization review, and discharge planning experience. Willing to consider candidates without case management experience who have three (3+) or more years of recent acute care clinical RN experience.

• Strong interpersonal skills.

• Proficiency in Information Systems and computer programs including MS Office (Word, Excel, Outlook, PowerPoint, etc.).

• BSN/MSN

• CCM

• Lean Six Sigma yellow belt or above.

• Three (3+) or more years of clinical RN experience.

• Proven home care, managed care, or similar case management experience.

• Proven home care, managed care, or similar case management experience.

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.
• This position will be a hybrid of work from home and on-site, with more being work from home once new hire is capable with their CCM knowledge.