Job Description

Filing Deadline: Mon 3/17/2025

UC San Diego values equity, diversity, and inclusion. If you are interested in being part of our team, possess the needed licensure and certifications, and feel that you have most of the qualifications and/or transferable skills for a job opening, we strongly encourage you to apply.

DESCRIPTION

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.

Inpatient UM Case Manager is responsible for concurrent and retro review of inpatient admissions to acute hospitals, long term acute hospital, inpatient acute rehabilitation, skilled nursing facility. Inpatient UM Case Manager is responsible for consistently applying MCG evidence based guidelines to determine the need for admission to the hospital or skilled nursing facility and continued stay. Inpatient UM case Manager is responsible for timely communication with in network and out of network hospitals to start discharge planning at the time of admission. Inpatient UM Case Manager is responsible to escalate cases not meeting MCG criteria or complex cases to the Medical Director for decision.

Inpatient UM Case Manager is responsible for authorizing DME, HH, SNF, LTACH, ARU services as part of discharge planning. Inpatient UM Case Manager acts as part of interdisciplinary care team, which includes medical directors, doctors, nurses, inpatient case managers, social workers, outpatient case managers, complex case managers, clinical support staff, administrative provider relations and other internal and external stake holders.

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

MINIMUM QUALIFICATIONS

  • Must be a graduate from an accredited school of Nursing.
  • RN license issued by the State of California.
  • Experience working as an Inpatient Case Manager performing concurrent utilization review and retro review.
  • Experience using MCG guidelines - inpatient and observation criteria.
  • Working knowledge and experience with members with Medicare/Med-Cal HMOs and benefits as well as commercial HMO health plan policies. Working knowledge and experience with DOFRs.
  • Proficiency in Information Systems and computer programs such as Word and Excel.
  • Must possess excellent interpersonal and communication skills.
  • Must be able to work within a team environment

PREFERRED QUALIFICATIONS

  • Three to five (3 - 5) years of experience working within IPA/MSO/Health Plan as Inpatient Case Manager - concurrent review and strong discharge planning skills.
  • BSN or Master's Degree.
  • ACM and/or CCM certificate.
  • Epic knowledge and experience.

SPECIAL CONDITIONS

  • 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.

Pay Transparency Act

Annual Full Pay Range: $164,597 - $164,597 (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent: $78.83 - $78.83

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).


If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.

UC San Diego is an Equal Opportunity/Affirmative Action 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.

For the University of California’s Affirmative Action Policy please visit: https://policy.ucop.edu/doc/4010393/PPSM-20
For the University of California’s Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.

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. "Misconduct" means any violation of the policies or laws governing conduct at the applicant's previous place of employment, including, but not limited to, violations of policies or laws prohibiting sexual harassment, sexual assault, or other forms of harassment, discrimination, dishonesty, or unethical conduct, as defined by the employer. For reference, below are UC's policies addressing some forms of misconduct:

Application Instructions

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