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Prime Healthcare

Acquires and reorganizes underperforming hospitals

Case Manager - RN, Utilization Management

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeChino, CA, USA$43.25 - $58.21In-person

About the Job

Requirements

  • A Bachelor of Social Work or another bachelor's degree in a related field is required.
  • At least one year of experience in case management, discharge planning, or nursing management is required.
  • Experience and knowledge in basic to intermediate computer skills are required.

Responsibilities

  • Manage the quality and resources of patients admitted to the facility from admission through the continuum of health care management.
  • Advocate on behalf of patients, promote cost containment, and integrate health care providers to support seamless care delivery.
  • Conduct holistic and comprehensive admission and concurrent medical-record reviews for medical necessity, intensity of service, and severity of illness.

Desired Qualifications

  • A minimum of five years of acute-care experience is preferred.
  • A Certified Case Manager credential is preferred, or it must be obtained within one year.
  • A current Basic Life Support certificate is preferred.
  • Knowledge of Milliman Criteria and InterQual Criteria is preferred.

About the Company

Prime Healthcare

Acquires and reorganizes underperforming hospitals

Prime Healthcare operates a network of hospitals and outpatient centers across the United States, concentrating on turning around financially struggling facilities. It invests in infrastructure and technology, restructures operations, and negotiates payer terms (including pursuing higher out-of-network reimbursements) to improve financial performance, and it manages both for-profit hospitals and not-for-profit facilities through the Prime Healthcare Foundation. The company aims to raise clinical quality and patient safety while expanding access in hundreds of communities, though it has faced legal and regulatory scrutiny over billing practices and service-line decisions. Its goal is to stabilize and improve the financial and clinical performance of underperforming hospitals so they can continue serving their communities.

Company size
5,001-10,000
Company stage
Debt Financing
Total funding
$2.2B
Headquarters
Ontario, CA
Founded
2001

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