Case Manager - Utilization Management

Overview

Founded in 1964, West Anaheim Medical Center is a 219-bed acute-care hospital dedicated to providing the community with high-quality, compassionate healthcare. Key services include general medical and surgical inpatient care and treatment, emergency services, surgical services, behavioral health, comprehensive heart center, and diagnostic imaging. For more information visit www.westanaheimmedctr.com.

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community!

Why Prime Healthcare? West Anaheim Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

West Anaheim Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs.

Our Total Rewards package includes, but is not limited to:

• Paid time off

• 401K retirement plan

• Outstanding Medical

• Dental

• Vision coverage

• Tuition reimbursement

• Many more voluntary benefit options!

Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time.

We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Responsibilities

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

BSW or other Bachelor degree in a related field or at least one year experience in case management, discharge planning or nursing management; CCM or obtained within 6 months of hire. Experience and knowledge in basic to intermediate computer skills.

Preferred qualifications:

Minimum 5 years of acute care experience preferred. At least one-year experience in case management, discharge planning or management, preferred.

Current BCLS certificate preferred. Knowledge of Milliman Criteria and InterQual Criteria preferred.

West Anaheim Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.

A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $30.28 to $43.32. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.