Health System Nurse Case Manager I/II - RUHS UR Case Management/Utilization Review - County of Riverside

ABOUT THE POSITION

The County of Riverside - Riverside University Health System-Medical Center is seeking highly skilled and experienced Registered Nurses to join our team as a Health System Nurse Case Manager with the UR Case Management Department.

The most competitive candidates will have three years of full time experience as a Registered Nurse in an acute care setting. Additionally, candidates should have at least one year of experience in either conducting case management or processing utilization review of healthcare services. A Bachelor's or Master's degree in Nursing is required for consideration as well.

Preferred Qualifications:

• Certification in Case Management (CCM)
• Experience with electronic health record systems (EPIC)
• Knowledge of healthcare regulations and reimbursement processes.

Work schedule:

• Night Shift - 6/12 & 1/8 schedule (three, twelve-hour shifts per work week and one alternating eight hour shift every other week)
• Hours: 7:00 pm to 7:30 am and one shift from 11:00 pm to 7:30 am
• Including weekends and holidays

Meet the Team!
To find out more about Riverside University Health System, please visit:
http://www.ruhealth.org

EXAMPLES OF ESSENTIAL DUTIES
Within the full scope of the Nursing Practice Act, assess, plan, organize, and provide nursing, case management and utilization review services for patients.

Evaluate healthcare services of requesting physicians based on the appropriateness of the service and the level of care at which service would be delivered; act as a neutral advocate for patients; act as a resource to physicians for adequate medical record documentation, appropriateness of facility services as they relate to diagnoses, and options for post-discharge care.

Perform utilization review in concert with the utilization review physician and make recommendations to approve, delay, modify, or deny treatment.

Coordinate and monitor patients through the hospitalization process utilizing physicians, nurses, other healthcare providers, and third party payors to maintain quality care and fiscal responsibility; monitor completion of healthcare services to avoid delays in care and discharge; facilitate third party reimbursement approval and/or authorization.

As directed, coordinate community-based medical post-discharge activities for patients; record and report significant changes in condition and general progress of patient, and provide preemptive recommendations.

Counsel and advise patients regarding proper healthcare methods; review the post-hospital care plan with the patient/family; follow plan through to discharge.

Prepare and maintain concise, complete records and reports, including post-discharge documentation.

May provide orientation and training to new staff; may identify staff training needs.

Participate in quality assurance and performance improvement reviews.

Participate in hospital utilization review committee activities.

May testify in court as to the client's mental and physical condition.

MINIMUM QUALIFICATIONS
Health System Nurse Case Manager I:
Pay Range: $48.4236 to $74.9477 per hour

Education: Successful completion of the coursework required to obtain a valid license to practice as a registered nurse in the State of California.
Experience: Three years of full time experience as a registered nurse in an acute care facility, mental health facility, or community health agency with references and evaluations to show appropriate skill level. One year of experience in Case Management and/or Utilization Review is preferred. (Possession of a Master's degree from an accredited college or university in nursing may be considered in lieu of one year of experience.)

Knowledge of: Case management and utilization review principles and practices; payor source documentation requirements and governmental regulations affecting reimbursement, managed care, and healthcare issues and standards; application of the nursing process; full range of registered nurse duties and responsibilities; community resources available to provide patient care and follow-up; federal, state, and local laws and regulations governing professional aspects of nursing; principles and methods of supervision and training; problem solving techniques.

Ability to: Plan, organize, supervise, and evaluate nursing services on specific unit(s); communicate effectively; positively manage change and conflict; interpret licensure and accreditation standards; analyze and draft department policies and procedures; apply productive problem solving skills; write clear and concise reports; perform registered nurse or public health nurse responsibilities according to the State of California Nursing Practice Act; implement the nursing process.

Health System Nurse Case Manager II:
Pay Range: $53.0510 to $79.9602 per hour

OPTION I
Education: Graduation from an accredited college or university with an Associate's degree in nursing.
Experience: Five years of full-time registered nurse experience in a managed care or acute care setting that includes a minimum of one year experience in Case Management and Utilization Review.

OPTION II
Education: Graduation from an accredited college or university with a Bachelor's degree in nursing.
Experience: Three years of full-time registered nurse experience in a managed care or acute care setting that included experience in Case Management and Utilization Review.

OPTION III
Education: Graduation from an accredited college or university with a Master's degree in nursing.
Experience: Two years of full-time registered nurse experience in a managed care setting that included experience in Case Management and Utilization Review.

Knowledge of: Case management and utilization review principles and practices; payor source documentation requirements and governmental regulations affecting reimbursement, managed care, and healthcare issues and standards; application of the nursing process; full range of registered nurse duties and responsibilities; community resources available to provide patient care and follow-up; federal, state, and local laws and regulations governing professional aspects of nursing; principles and methods of supervision and training; problem solving techniques.

Ability to: Plan, organize, supervise, and evaluate nursing services on specific unit(s); communicate effectively; positively manage change and conflict; interpret licensure and accreditation standards; analyze and draft department policies and procedures; apply productive problem solving skills; write clear and concise reports; perform registered nurse or public health nurse responsibilities according to the State of California Nursing Practice Act; implement the nursing process.

Other Requirements for Both Levels I and II:
License: Must maintain a current, valid license to practice as a Registered Nurse in the State of California.

Certification: Must maintain a valid Basic Life Support (BLS) certificate issued by the American Heart Association for professional healthcare providers.

Possession of a valid California Driver's License may be required.

Additional Requirement for Level II:
Certification: Must maintain a current and valid Case Manager Certification.

SUPPLEMENTAL INFORMATION
What's Next?
Open to All Applicants
This recruitment is open to all applicants.
Applicants who are current County of Riverside employees and/or current employees of the RUHS Division may be considered before other applicants depending on the volume of applications received.

Application Period
BASED ON THE NUMBER OF APPLICATIONS RECEIVED, THIS POSTING MAY CLOSE WITHOUT NOTICE.
Applications received prior to the closing date will be considered based on the information submitted. Changes or alterations cannot be accepted. All applicants must submit a complete application by the closing date of this recruitment. No late applications will be permitted.
Include relevant work experience details on resume and/or application.
Applicants who fail to provide information demonstrating they possess the position requirements may not be considered further in the application process. A description of job duties directly copied from the job classification or job posting will not be considered.

Qualified applicants may be considered for future vacancies throughout the County.

Upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account. If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services ( NACES ) or Association of International Credential Evaluators, Inc. ( AICE ).

For more information regarding this position, please contact the recruiter, Lisette Jimenez via email at lijimenez@rivco.org .

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APPLICATION INFORMATION

Veteran's Preference
The County has a Veterans Preference Policy applicable to new hires. To qualify, upload a copy of your (or your spouse's) Member-4 Form DD-214 indicating dates of service, and a copy of your spouse's letter of disability (if applicable) with your application. For privacy reasons, it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans' preference.The Veterans Preference Policy, C-3 is available here: https://rivcocob.org/board-policies

Reasonable Accommodations
The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation, please visit the Disability Access Office web page located at: https://rc-hr.com/disability

Proof of Education
If using education to qualify or when requested by the recruiter, upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.

If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services ( NACES ) or Association of International Credential Evaluators, Inc. ( AICE ).

Equal Opportunity Employer
The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition (cancer and genetic characteristics), genetic information, or denial of medical and family care leave, or any other non-job-related factors.

Pre-Employment
All employment offers are contingent upon successful completion of pre-employment requirements including a criminal background investigation, which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A pre-employment physical examination and background check may be required.

Probationary Period
As an Approved Local Merit System, all County of Riverside employees, except those serving "At Will," are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding, County Resolution, or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.

General Information
Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies.

Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume, as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.

Please read and follow any special application instructions on this posting. Click the 'Apply' link located on this page to submit your application. For additional instructions on the application process, examinations, Veteran's preference, pre-employment accommodation or other employment questions, please refer to our web site, www.rc-hr.com .

If you are experiencing technical problems, you may contact the governmentjobs.com applicant support desk Monday through Friday, 6 am to 5 pm Pacific Time at support@governmentjobs.com or toll-free 1-855-524-5627.

MEDICAL/DENTAL/VISION INSURANCE: A choice of different medical, dental and visions plan are available to elect. The County provides a Flexible Benefit Credit contribution as governed by the applicable SEIU Memorandum of Understanding to contribute towards the cost of these plans.

Note: Employees on assignment through the Temporary Assignment Program (TAP) receive different benefits. See the list here .
MISCELLANEOUS RETIREMENT: County of Riverside has three retirement Tiers through the California Public Employees' Retirement System (CalPERS).

• Tier I (Classic Member - Formula 3% @ 60): Applicable to current and former County of Riverside local miscellaneous employees hired prior to 08/24/2012 and did not withdraw CalPERS contributions. The employee contribution is eight (8%) percent.
• Tier II (Classic Member - Formula 2% @ 60): Applicable to local miscellaneous employees 1) hired after 08/23/2012 through 12/31/2012; 2) Previously employed with another CalPERS contracting public agency or a reciprocal retirement system, with a break in service of less than six months between the separation date with the previous employer and the appointment date with the County of Riverside. The employee contribution is seven (7%) percent.
• Tier III (PEPRA New Member - Formula 2% @ 62): Applicable to CalPERS local miscellaneous new members hired on or after the implementation of the Public Employees' Pension Reform Act of 2013 (PEPRA) which took effect January 1, 2013. Effective July 1, 2023 employee contributions are 7.25% and will increase to 7.75% effective July 1, 2024.

A new member is defined as any of the following:

A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who has no prior membership in any California Public Retirement System.

A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who was a member with another California Public Retirement System prior to that date, but who is not subject to reciprocity upon joining CalPERS.

A member who first established CalPERS membership prior to January 1, 2013, and who is rehired by a different CalPERS agency after a break in service of greater than six (6) months.

CalPERS refers to all members that do not fit within the definition of a new member as "classic members".

Contribution rates are subject to change based on the County of Riverside annual actuarial valuation.

Note:

This summary is for general information purposes only. Additional questions regarding retirement formulas can be sent to retirement@rivco.org or by calling the Benefits Information Line at (951) 955-4981,
Option 2.

If you have prior service credit with another CalPERS agency or within agencies, please contact CalPERS at (888) 225-7377 to determine which retirement tier would be applicable to you. CalPERS is governed by the Public Employees' Retirement Law. The Retirement Law is complex and subject to change. If there's any conflict between this summary and the law, the law will prevail over this summary.
DEFERRED COMPENSATION: Voluntary employee contribution with a choice between two 457 deferred compensation plan options.

VACATION ACCRUAL (Bi-Weekly Accrual):

0< 3 year = 80 Hours (10 Days)

4< 9 years = 120 Hours (15 Days)

10 or more years = 160 Hours (20 Days)

Maximum Vacation leave accumulation is 480 hours.

SICK LEAVE: Four (4) hours Sick Leave accrual per pay period with unlimited accrual.

HOLIDAYS: Normally 12 paid holidays per year.

BEREAVEMENT LEAVE: Allowed 5 days (3 days are County paid; 2 additional days can be taken from accrued Sick Leave balance).

BASIC LIFE INSURANCE: Equal to one times annual base salary not to exceed $50,000 of term life coverage. Premiums are paid by the County. Additional Supplemental Life plan is available for employee purchase.

DISABILITY: Short-term Disability benefit pays up to a maximum of $461.54 weekly, payable up to a maximum of 52 weeks.

POST RETIREMENT MEDICAL CONTRIBUTION: A monthly contribution is made by the County towards retiree health insurance offered through the County as governed by the applicable SEIU Memorandum of Understanding.

OTHER: There may be other benefit provisions as specified in the applicable Memorandum of Understanding. Please contact the recruiter listed on the job posting directly for more information.