We have been in the community since 1935. Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region. Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development. Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare.
Riverside Medical Clinic is the best place to work, practice medicine, and receive care.

SUMMARY: Under the general direction of the Director of Utilization Management, the RN Case Manager identifies, plans, and coordinates high-risk patient care (frail, chronic disease, catastrophic injury) in an ambulatory setting. Reviews referrals and applies the CM standards for patient care. Ensures continuity of care across the continuum. Promotes and evaluates quality and cost-effective outcomes.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

HOURS: Monday- Friday 8:30AM- 5:30PM

EDUCATION and/or EXPERIENCE: Graduate of an accredited RN Program. At least two years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience. Proficiency in MS Excel and strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data. Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management and project management skills.

CERTIFICATES, LICENSES, AND REGISTRATIONS: Current California RN license. Certification in Case Management, preferred.

Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Note: (other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing).

1. Assess the physical, functional, social, psychological, environmental, learning and financial needs of patients
2. Identify problems, goals and interventions designed to meet patient’s needs, including prioritized goals that consider the patient/caregivers goals, preferences and desired level of involvement in the case management plan.
3. Create care plan including objectives, goals and actions designed to meet patient’s needs.
4. Provide appropriate interventions which demonstrate knowledge of and sensitivity toward cultural diversity and religious, developmental, health literacy, and educational backgrounds of the population served. Utilize interpreter services per policy.
5. Assess the patient’s formal and informal support systems, including caregiver resources and involvement as well as available benefits and/or community resources.
6. Implement and monitor the care plan to ensure the effectiveness and appropriateness of services
7. Evaluate patient’s progress toward goal achievement, including identification and evaluation of barriers to meeting or complying with case management plan of care, and systematically reassess for changes in goals and/or health status.
8. Research alternative treatment options and selecting and locating appropriate providers which can include facilitation of referrals.
9. Communicates with primary care physician and members of the comprehensive care team regarding status of patient.
10. Utilize motivational interviewing skills to build patient engagement in case management plan of care.
11. Provide education, information, direction and support related to care goals of patients.
12. Act as a patient advocate and assist with problem solving and addressing any barriers to care or compliance with care plan.
13. Coordinate care and develop treatment plans.
14. Provide referrals to appropriate community resources; facilitate access and communication when multiple services are involved; monitor activities to ensure that services are actually being delivered and meet the needs of the patient, coordinate services to avoid duplication.
15. Maintain accurate patient records and patient confidentiality.
16. Measure outcomes and effectiveness of case management including clinical, financial, quality of life and patient/family satisfaction.
17. Engage in professional development activities to keep abreast of case management practices and patient engagement strategies.
18. Facilitate disease prevention and health promotion with patients and families
19. Determine psychosocial needs & complex medical needs of all patients
20. Orient providers to managed care and RMC goals and philosophies.
20. Initiate required QRM reports per company policy.
21. Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization.

Challenging and rewarding work environment
Growth and Development Opportunities within UHS and its Subsidiaries
Competitive Compensation

One of the nation’s largest and most respected hospital companies, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. In 2017, UHS was recognized as one of the World’s Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America’s Top 500 Public Companies.

Our operating philosophy is as effective today as it was 40 years ago: Build or acquire high quality hospitals in rapidly growing markets, invest in the people and equipment needed to allow each facility to thrive, and become the leading healthcare provider in each community we serve.

Headquartered in King of Prussia, PA, UHS has more than 81,000 employees and through its subsidiaries operates more than 320 acute care hospitals, behavioral health facilities and ambulatory centers in the United States, Puerto Rico, the U.S. Virgin Islands and the United Kingdom.

UHS is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at UHS via-email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.