Utilization Management Case Manager

Santa Barbara Cottage Hospital seeks a Utilization Management Case Manager for their Case Management department, responsible for utilization management, quality assurance, and discharge planning activities for assigned services/areas/patients within Cottage Health. Case management activities will result in quality outcomes, optimal care/cost management of services and/or procedures, a high level of customer satisfaction, and contribution to an overall value-oriented experience of stakeholders and persons served.

• Coordinate discharge planning, assess post-discharge needs, arrange appropriate referrals and services, facilitate care transitions, and maintain required documentation.
• Coordinate appropriate, cost-effective care by verifying benefits, facilitating services within coverage guidelines, escalating complex cases as needed, and maintaining required utilization and reimbursement documentation.
• Support quality improvement initiatives by monitoring case management outcomes, identifying trends and risks, participating in performance improvement activities, and assisting with denial, appeal, and risk management processes.
• Educate patients and families on the care plan, available resources, treatment options, and care transitions, collaborating with the interdisciplinary team to support informed decision-making.
• Collaborate with interdisciplinary teams to support care planning, provide case management guidance and education, contribute to performance improvement initiatives, and foster professional growth and best practices.

QUALIFICATIONS:

All job qualifications listed indicate the minimum level necessary to perform this job proficiently.

Education:

• Minimum: Associate's Degree in Nursing (ADN).
• Preferred: Bachelor's Degree in Nursing (BSN).

Certifications, Licenses, Registrations:

• Minimum: Current California Nursing license in good standing.
• Preferred: Certification in Case Management.

Years of Related Work Experience:

• Minimum: 2 years direct patient care experience in an acute care setting. Other patient care experience may be considered.
• Preferred: Previous experience as a case manager in an acute care setting.