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RN Case Manager

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Rady Children's Hospital-San Diego

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Location:
United States , San Diego

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Category:
Nursing

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Contract Type:
Not provided

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Salary:

58.87 - 101.33 USD / Hour
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Job Description:

Rady Children’s nurses serve as local and global leaders in shaping how care is delivered to patients and families throughout our organization and in the communities we serve. Behind each nurse and their leader is the commitment to learn more, improve outcomes and empower individuals to seek innovative solutions. We are transforming the role of the caregiver, and in that transformation, we are partners in advancing the quality of care. Every day, we look for new pathways. It is a journey of excellence.

Job Responsibility:

  • Function as liaisons between patients, their families, payors, and healthcare personnel to ensure appropriate movement along the continuum of care
  • Coordinate discharge needs, quality of care, and implement the utilization management process for acute inpatients
  • Perform concurrent review and denials management based on acute care guidelines with a focus on authorization and reimbursement, appropriateness of admission, length of stay, and avoidable delays in discharge
  • Collaborate with the family, the care team, third party payors, and outside providers to coordinate discharge needs including home health, durable medical equipment, and safe transitions of care

Requirements:

  • BLS for Health Providers (American Heart Association)
  • California RN License
  • Bachelor's Degree in Nursing
  • 4 years nursing in an acute hospital or 2 years Case Management, Utilization Review, or Discharge Planning experience in an acute hospital

Nice to have:

  • Experience in a pediatric acute hospital
  • Familiarity with Interqual or Milliman Care Guidelines
  • Experience navigating the electronic medical record (Epic)
What we offer:
  • Medical, Dental, Vision
  • 403(b) Retirement Plan with 100% employer match up to 3% of your salary
  • Tuition Reimbursement up to $2,000 per year, paid time off for seminars
  • Life and Disability Insurance
  • Infertility Reimbursement
  • Annual merit increases, longevity increases, success sharing, paid leave cash-out program
  • Annual Team Rady event, milestone awards, CARES recognition

Additional Information:

Job Posted:
January 01, 2026

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