Utilization Review Case Management Rn Jobs in Ione, CA

The Clinical Case Manager facilitates the integration and coordination of major aspects of utilization review and discharge planning for patient needs. This position requires a high level of clinical judgment, problem-solving skills, creativity, organizational and priority setting abilities, with excellent communication skills. Critical aspects of the role involve the assessment of clinical information to determine medical necessity for the identified level of care, assessment for appropriate services needed and resources available, and to facilitate the coordination of both internal and external health care providers to ensure optimal continuity of appropriate and cost-effective care.
The Clinical Case Manager must effectively communicate with both internal and external providers and health plans, as well as community resources, to optimize medically necessary services. The Clinical Case Manager demonstrates the ability to fulfill responsibilities through clinical assessment, accurate and sound judgment, application of standardized criteria, and maintaining professional communication. The goal of coordinated discharge planning and utilization is achieved by actively directing and involving members of the multi-disciplinary team, outside providers, community resources, and third-party payors. The Clinical Case Manager accurately maintains and tracks pertinent data and statistics specific to area of practice, such as delays in service, patients who lack medical necessity for acute hospital admission, denials for continued stays, and other factors affecting appropriate utilization of health system resources.
Apply By Date : September 23, 2026 at 11:59pm PST.
Minimum Qualifications - For full consideration, applicants are encouraged to upload license and/or certification if required of the position

• Valid California Registered Nurse License without restriction
• Graduation from an accredited school of nursing.
• Minimum of one (1) year recent Case Management experience in discharge planning and/or Utilization Review in an acute hospital.
• Knowledge of Medicare, Medi-Cal, and HMO legislation, third party payor contracts, Title XXII, the Joint Commission. Demonstrated knowledge of how these programs/regulations affect the functions and role of the department.
• Demonstrated ability to incorporate them into departmental systems/processes.
• Knowledge of professional and ethical standards related to Clinical Case Management such as the Nursing Practice Act, the Codes of Ethics from the American Nurses Association and the Standards of Practice & Scope of Services by the American Case Management Association.
• Ability to read and comprehend English text and medical terminology; knowledge of medical and nursing treatment plans, levels of care, and area resources; skill in assessing the appropriateness of medical admissions and continued stay.
• Skill to perform in-depth chart analysis to provide accurate information in a concise, informative manner, identify/analyze problems or issues related to areas of responsibility, developing an appropriate plan, and considering medical needs and resources available.
• Ability to organize and direct varied health care team professionals in a manner that establishes a good rapport and professional working relationship.
• Ability to work efficiently and independently, maintaining a calm manner while under pressure.
• Ability to organize work to accommodate special projects, deadlines and priorities; ability to be both flexible and adaptable in order to coordinate multiple variables and to respond to the need of a multi-faceted work area.
• Clinical skills and knowledge base to assess and refer to discharge planning, possible needs for care necessary to meet patient's needs on discharge.
• Knowledge and understanding of the need to utilize discretion and maintain confidentiality when discussing patient matters.
• Ability to successfully apply interpersonal communication skills in areas such as conflict management.

Preferred Qualifications

• Bachelor of Science in Nursing (BSN).

Key Responsibilities

• 30% - Utilization Review and Case Finding
• 30% - Coordination and Implementation of Discharge Plan
• 15% - Communication, Coordination and Documentation
• 10% - Secure Authorization for Care and Reimbursement for Hospital and Physician
• 10% - Denials and Appeals Management
• 5% - Quality and Education

Department Overview
The purpose of the Clinical Case Manager is to support the interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Clinical Case Manager helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction). The Clinical Case Manager is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and create a safe discharge plan. Facilitation of the collaborative management of patient care across the continuum, completing utilization review around LOC and authorization concerns, and intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement.
POSITION INFORMATION

• Salary or Pay Range: $ 75.58 - $110.71
• Salary Frequency: Hourly
• Salary Grade: 105
• UC Job Title: CASE MGR NEX
• UC Job Code: 007871
• Number of Positions: 4
• Appointment Type: Staff: Career
• Percentage of Time: 100 %
• Shift (Work Schedule): Monday-Friday, Rotating Weekends and Holidays
• Location: Medical Records Building (HSP012)
• Union Representation: HX-Healthcare Professionals
• Benefits Eligible: Yes
• This position is 100% on-site

Benefits
Outstanding benefits and perks are among the many rewards of working for the University of California. UC Davis offers a full range of benefits, resources and programs to help you bring your best self to work, as well as to help you and your family achieve your health, wellness, financial and career goals. Learn more about the benefits below and eligibility by visiting UCnet Benefits Page or Benefits Summary for UC Davis Health Employees or Benefits Summary for UC Davis Employees .

• High quality and low-cost medical plans to choose from to fit your family's needs
• UC pays for dental and vision coverage for you and your family
• Retirement plans for eligible employees including Pension and other Retirement Saving Plans
• Supplemental insurance offered including additional life , short/long term disability , pet insurance , legal coverage , accident, critical illness and hospital indemnity
• Pregnancy and Parental Leave , Family & Medical Leave , Adoption Assistance and Pay for Family Care and Bonding for eligible employees
• Lactation Support Program and Family Care discounts and resources
• Employee Well-being resources and programming to support thriving in all aspects of employee's lives
• On-site Employee Assistance Program including access to free mental health services
• Generous amount of paid Holidays annually as outlined in the UC Policies or Collective Bargaining Agreements
• Paid Time Off/Vacation/Sick Time as outlined in the UC Policies or Collective Bargaining Agreements
• Continuing Education (CE) allowance and Staff Education Reimbursement Program for eligible employees
• Access to free professional development courses and learning opportunities for personal and professional growth
• Public Service Loan Forgiveness (PSLF) Qualified Employer and Student Loan Debt Counseling Program for eligible employees

Physical Demands

• Standing - Occasional Up to 3 Hours
• Walking - Occasional Up to 3 Hours
• Sitting - Frequent 3 to 6 Hours
• Lifting/Carrying 0-25 Lbs - Occasional Up to 3 Hours
• Pushing/Pulling 0-25 Lbs - Occasional Up to 3 Hours
• Bending/Stooping - Occasional Up to 3 Hours
• Squatting/Kneeling - Occasional Up to 3 Hours
• Twisting - Occasional Up to 3 Hours
• Climbing (e.g., stairs or ladders) - Occasional Up to 3 Hours
• Reaching overhead - Occasional Up to 3 Hours
• Keyboard use/repetitive motion - Frequent 3 to 6 Hours

Environmental Demands

• Loud noise levels - Occasional Up to 3 Hours
• Marked changes in humidity or temperature - Occasional Up to 3 Hours

Mental Demands

• Sustained attention and concentration - Frequent 3 to 6 Hours
• Complex problem solving/reasoning - Frequent 3 to 6 Hours
• Ability to organize & prioritize - Frequent 3 to 6 Hours
• Communication skills - Frequent 3 to 6 Hours
• Numerical skills - Occasional Up to 3 Hours
• Constant Interaction - Frequent 3 to 6 Hours
• Customer/Patient Contact - Frequent 3 to 6 Hours
• Multiple Concurrent Tasks - Frequent 3 to 6 Hours

Work Environment
UC Davis is a smoke and tobacco free campus effective January 1, 2014. Smoking, the use of smokeless tobacco products, and the use of unregulated nicotine products (e-cigarettes) will be strictly prohibited on any UC Davis owned or leased property, indoors and outdoors, including parking lots and residential space.
Has mandatory reporting responsibilities for domestic violence, child abuse and elder/dependent abuse. Works overtime as defined by the collective bargaining agreements, floats to other areas and works weekends and holidays. References reflect an overall meet or exceeds.
Special Requirements - Please contact your recruiter with questions regarding which activities apply by position

• This is a critical position, as defined by UC Policy and local procedures, and as such, employment is contingent upon clearing a criminal background check(s) and may include drug screening, medical evaluation clearance and functional capacity assessment
• This position is designated as a mandated reporter under CANRA and UC policy, and employment is contingent on compliance with applicable policies, procedures and training requirements

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.
A Culture of Opportunity and Belonging
At UC Davis, we're committed to solving life's most urgent challenges and building a healthier, more resilient world. We believe in growing through every challenge, continually striving to improve, and welcoming new perspectives that strengthen our community. We recognize that a vibrant and innovative organization values both individual strengths and shared purpose. The best ideas often emerge when people with different experiences come together.
As you consider joining UC Davis, we invite you to explore our Principles of Community , our Clinical Strategic Plan and strategic vision for research and education. We believe you belong here. The University of California, Davis is an Equal Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.
To view the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination
Because we want you to feel seen and valued, our recruitment process at UC Davis supports openness and authenticity. Research shows that some individuals hesitate to apply unless they meet every qualification. You may be an excellent fit for this role-or the next one. We encourage you to apply even if your experience doesn't match every listed requirement. #YouBelongHere
To learn more about our background check program, please visit: https://hr.ucdavis.edu/departments/recruitment/ucd/selection/background-checks
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