Case Manager EX - Utilization Management

📋 Description

• The Case Manager will manage utilization review activities, coordinate resources, and support
• Review admissions and ongoing care needs; monitor resource utilization; evaluate services across
• Perform utilization reviews using approved criteria, including severity and intensity-of-service
• Analyze utilization patterns to support operational improvements and quality initiatives.
• Participate in denial management, audits, and utilization monitoring projects.
• Review medical records and collaborate with physicians to improve clinical documentation and

🎯 Requirements

• Current Registered Nurse (RN) license required.
• Bachelor of Science in Nursing (BSN) required for external candidates.
• Minimum 5 years of clinical experience and 1 year of case management preferred.
• Strong understanding of patient acuity, documentation, and utilization management practices.
• Knowledge of regulatory standards (Joint Commission, CMS, CDPH, CCS).
• Excellent written and verbal communication; strong teamwork and IT skills (Word, Excel, PowerPoint

🎁 Benefits

• Medical insurance coverage.
• Retirement savings plans.
• Paid sick leave and vacation time.
• Employee discounts and wellness programs.
• Professional development opportunities and continued learning support.
• Collaborative workplace focused on patient care, innovation, research, and education.