Utilization Management Case Manager

Santa Barbara Cottage Hospital seeks a Utilization Management Case Manager for their SBCH Care Management department responsible for the 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. 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.