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.

Cottage Health is a leading acute care hospital system, located on the central coast of California, widely known for our superior patient care, innovation, medical research and education. Our health system operates primarily in Santa Barbara, CA, since 1888, and consists of three acute care hospitals, a Rehabilitation Hospital, multiple clinics and a multi-site Urgent Care system. Our mission is to serve the central coast communities with excellence, integrity, and compassion. Every day we touch thousands of lives in many different ways, resolute in our mission to put patients first. We take pride in helping our patients get back to living their lives - in the places they love.

*Pay for non-physician positions is determined based on related years of experience and internal equity. Eligible employees may also receive additional forms of compensation, including shift differentials, on-call pay, incentive pay, and bonus opportunities, where applicable. Manager and above positions may participate in Cottage Health’s annual management incentive program. Physician compensation is determined based upon specialty and may include bonus potential. For more information on our comprehensive Total Rewards offerings, please visit https://cottagehealth.org/careers/total-rewards .

If you're already a Cottage Health employee, please apply on this link only.