Case Manager - PVH Utilization Management

Overview:

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Paradise Valley Hospital, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

Paradise Valley Hospital is the South Bay’s oldest hospital, the second oldest hospital in all of San Diego County, and the largest employer in National City. For more than 100 years, Paradise Valley Hospital has served San Diego faithfully, proud of our heritage and providing numerous programs and services to meet the changing needs of our community. Our 291-bed, acute care hospital features

the San Diego Spine & Joint Center, a highly credentialed acute rehabilitation center, our Paradise Health & Senior Center, a fully equipped and modern cardiac catheterization lab, and comprehensive inpatient and outpatient surgical services, and 24-hour emergency services.

In addition to our healthcare services, we offer comprehensive behavioral health services on the hospital campus and Bayview campus in Chula Vista. Services include psychiatric continuum of care for adult patients, inpatient services, and intensive outpatient services. Learn more at https://www.paradisevalleyhospital.net/.

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

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.

Education and Work Experience

Required qualifications:

1. BSW or other Bachelor degree in a related field. At least one year experience in case management, discharge planning or nursing management;
2. CCM or obtained within 6 months of hire.
3. Experience and knowledge in basic to intermediate computer skills.
4. Behavioral Violence Prevention Training within 3 months of hire and maintain current.

Preferred qualifications:

1. Minimum 5 years of acute care experience preferred.
2. At least one-year experience in case management, discharge planning or management, preferred.
3. Current BCLS (AHA) certificate preferred.
4. Knowledge of Milliman Criteria and InterQual Criteria preferred.

Paradise Valley Hospital 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 $41.00 to $65.00. 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.