Utilization Management Case Manager Lead

Santa Barbara Cottage Hospital seeks a Utilization Management Case Manager Lead for its Care Management department to provide education on current and updated regulatory compliance and to orient and train all new hires. Assists Manager of Case Management with meetings, audits, and other tasks assigned by the Manager of Case Management.

• Coordinate appropriate, cost-effective care by verifying benefits, utilizing available resources, escalating cases requiring intervention, and maintaining accurate documentation in the medical record and payer systems.
• Develop and coordinate discharge plans, identify post-discharge needs, arrange appropriate services and resources, facilitate care transitions, and maintain accurate documentation.
• Support quality and performance improvement initiatives, monitor trends, assist with denials and appeals, and participate in risk management activities.
• Educate patients and families on care plans, treatment options, available resources, and healthcare decisions, while coordinating education with the care team as needed.
• Collaborate with interdisciplinary teams, provide case management guidance and support, participate in care planning activities, and pursue ongoing professional development to enhance patient outcomes and organizational performance.
• Train and orient new staff, provide education on regulatory compliance, and support case management operations through audits, meetings, and administrative activities.

QUALIFICATIONS:

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

Education:

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

Certifications, Licenses, Registrations:

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

Years of Related Work Experience:

• Required: 3 years as a case manager in an acute care setting. Other patient care experience may be considered.
• Preferred: 5 years of experience as a case manager in an acute care setting.