Patient Services Coordinator-CHC-Women's Health Clinic
County of Riverside
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Posted: February 20, 2026 (1 day ago)
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Health System Nurse Case Manager I/II - RUHS Medical Center - Utilization Review/Case Management
County of Riverside
RUHS-Medical Center
Location
Riverside, California, 92502-1569
Salary
$50.36 - $83.15
per hour
Type
Full-Time
More Healthcare & Medical jobs →Closes
February 28, 2026
SES Pay Grade
Base salary range: $147,649 - $221,900
Typical requirements: Executive-level leadership experience. Senior executive qualifications required.
Note: Actual salary includes locality pay (15-40%+ depending on location).
Job Description
Summary
This job involves working as a nurse case manager in a hospital setting, where you'll coordinate patient care from admission to discharge, ensure treatments are appropriate and cost-effective, and help with insurance approvals and follow-up care after patients leave the hospital.
It's a great fit for experienced registered nurses who enjoy organizing healthcare services and have a background in managing hospital cases.
The role offers a supportive environment in a major medical center focused on trauma, stroke, and pediatric care.
Key Requirements
- Valid Registered Nurse (RN) license
- Experience in acute hospital case management and utilization review
- Knowledge of InterQual criteria for evaluating patient care
- Case Manager Certification (CCM) preferred
- Familiarity with electronic health record systems like EPIC
- Understanding of healthcare regulations and reimbursement processes
- Ability to coordinate care with physicians, nurses, and third-party payors
Full Job Description
The most competitive candidates for this role will have a strong background in hospital case management and utilization review management. Experience with or a thorough knowledge of InterQual criteria is highly preferred, as it will enhance the candidate's ability to evaluate and coordinate care effectively.
Highly Preferred Qualifications:
- Acute Hospital Case Management and Utilization Review experience is highly preferred.
- Case Manager Certification (CCM)
- Interqual experience/Interqual certification a plus
- Knowledge in electronic health record systems (EPIC)
- Knowledge of healthcare regulations and reimbursement processes.
Work Schedule:
9/80, Monday to Friday, with every other Friday offHours: 8:00 am to 5:30 pm
Health System Nurse Case Manager I: $50.3605 - $77.9456 per hour
Health System Nurse Case Manager II: $55.1731 - $83.1586 per hour
Health System Nurse Case Manager II: $55.1731 - $83.1586 per hour
Meet the Team!At Riverside University Health System Medical Center, nursing is more than a job, it’s an opportunity to make a real difference in a vibrant and diverse community.
Nationally recognized for its forward-thinking and innovative approach to patient care, RUHS Medical Center is also a proud teaching hospital and one of the top employers in the region.Our 439-bed facility is a designated Level I Trauma Center, Primary Stroke Center, and home to the region’s only Pediatric Intensive Care Unit (PICU).
Here, you’ll gain valuable experience across a wide range of specialties, including trauma care, stroke, pediatrics, and critical care.We are committed to your professional growth, offering continuous education, training, and career development programs in a collaborative, supportive, and rewarding environment.
Whether you’re an experienced nurse or just starting your career, RUHS Medical Center provides unparalleled opportunities to learn, grow, and make a meaningful impact.Could you see yourself making a difference here?Discover more about RUHS Medical Center at www.ruhealth.org.
Requirements
• Within the full scope of the Nursing Practice Act, plan, implement, coordinate, monitor, and evaluate medical services; provide nursing case management, discharge planning and utilization review services to patients; act as department resource for medical inquiries, claim file reviews and utilization review.
• Coordinate and monitor patients through the hospitalization process utilizing physicians, nurses, other healthcare providers, and third-party payors to maintain quality care and fiscal responsibility; monitor completion of healthcare services to avoid delays in care and discharge; facilitate third party reimbursement approval and/or authorization.
• Provide and coordinate community-based medical post-discharge activities for patients provide early medical management intervention for new patient illness/disease, consulting on medical only files and utilization review on all requests for medical treatment; review the post-hospital care plan with the patient/family; follow plan through to discharge.
• Evaluate healthcare services of requesting physicians based on the appropriateness of the service and the level of care at which service would be delivered; act as a neutral advocate for patients; act as a resource to physicians for adequate medical record documentation, appropriateness of facility services as they relate to diagnoses, and options for post-discharge care.
• Perform utilization review in concert with the utilization review physician to approve, delay, modify, or deny treatment.
• Perform medical reviews on patient services claims and provide recommendations, which are preemptive and focused on moving the patient along the healing continuum.
• Apply clinical expertise as a resource to case management staff, physicians, nurses, and other healthcare providers to identify the best results while coordinating the appropriate resource utilization; identify and manage patient problems to eliminate duplication and fragmentation of healthcare services.
• Counsel and advise patients regarding proper healthcare methods.
• Assist in the development of policies and procedures, standards of care and practice, and in the monitoring of those standards to ensure regulatory compliance, as required by the Joint Commission, Centers for Medicare and Medicaid Services, and the State of California Department of Health Care Services.
• Prepare and maintain concise, complete records and reports, including post-discharge documentation.
• Promote collaboration among hospital interdisciplinary departments, programs, and physicians; represent the Case Management and Utilization Review Department when needed in hospital committee meetings.
• Provide orientation and training to new staff; identify staff training needs.
• Participate in quality assurance and performance improvement reviews.
• Coordinate and monitor patients through the hospitalization process utilizing physicians, nurses, other healthcare providers, and third-party payors to maintain quality care and fiscal responsibility; monitor completion of healthcare services to avoid delays in care and discharge; facilitate third party reimbursement approval and/or authorization.
• Provide and coordinate community-based medical post-discharge activities for patients provide early medical management intervention for new patient illness/disease, consulting on medical only files and utilization review on all requests for medical treatment; review the post-hospital care plan with the patient/family; follow plan through to discharge.
• Evaluate healthcare services of requesting physicians based on the appropriateness of the service and the level of care at which service would be delivered; act as a neutral advocate for patients; act as a resource to physicians for adequate medical record documentation, appropriateness of facility services as they relate to diagnoses, and options for post-discharge care.
• Perform utilization review in concert with the utilization review physician to approve, delay, modify, or deny treatment.
• Perform medical reviews on patient services claims and provide recommendations, which are preemptive and focused on moving the patient along the healing continuum.
• Apply clinical expertise as a resource to case management staff, physicians, nurses, and other healthcare providers to identify the best results while coordinating the appropriate resource utilization; identify and manage patient problems to eliminate duplication and fragmentation of healthcare services.
• Counsel and advise patients regarding proper healthcare methods.
• Assist in the development of policies and procedures, standards of care and practice, and in the monitoring of those standards to ensure regulatory compliance, as required by the Joint Commission, Centers for Medicare and Medicaid Services, and the State of California Department of Health Care Services.
• Prepare and maintain concise, complete records and reports, including post-discharge documentation.
• Promote collaboration among hospital interdisciplinary departments, programs, and physicians; represent the Case Management and Utilization Review Department when needed in hospital committee meetings.
• Provide orientation and training to new staff; identify staff training needs.
• Participate in quality assurance and performance improvement reviews.
• May testify in court as to the client's mental and physical condition.
Qualifications
Salary Range: $50.3605/hour to $77.9456/hour
Education: Successful completion of the coursework required to obtain a valid license to practice as a Registered Nurse in the State of California.
Experience: Three years of full-time experience as a Registered Nurse in an acute care facility, mental health facility or community health agency with references and evaluations to show appropriate skill level. Additional qualifying experience as a full-time Licensed Vocational Nurse (LVN) may substitute for the required Registered Nurse experience up to three years on the basis of two years of full-time experience as an LVN equaling one year of full-time Registered Nurse experience. Licensed Vocational Nurse experience must be in an acute care setting within a hospital. One year of experience in Case Management and/or Utilization Review is preferred. (A bachelor's degree from an accredited college or university in nursing may substitute for one year of the required experience.)
Experience: Three years of full-time experience as a Registered Nurse in an acute care facility, mental health facility or community health agency with references and evaluations to show appropriate skill level. Additional qualifying experience as a full-time Licensed Vocational Nurse (LVN) may substitute for the required Registered Nurse experience up to three years on the basis of two years of full-time experience as an LVN equaling one year of full-time Registered Nurse experience. Licensed Vocational Nurse experience must be in an acute care setting within a hospital. One year of experience in Case Management and/or Utilization Review is preferred. (A bachelor's degree from an accredited college or university in nursing may substitute for one year of the required experience.)
Ability to: Perform the full range of nursing duties and responsibilities in a patient care setting; plan and organize nursing plans for patients; prepare and maintain concise, complete records and reports; establish and maintain effective working relationships with physicians, patients and fellow employees; make recommendations regarding continued stay necessity and appropriateness of the level of the delivery of care; identify discharge needs; use ancillary services and discharge plans; assist in the instruction of entry level nurses and ancillary personnel; keep abreast of developments in area of nursing specialization.
Health System Nurse Case Manager II:
Salary Range: $55.1731/hour to $83.1586/hour
Option I:
Education: Successful completion of the coursework required to obtain a valid license to practice as a Registered Nurse in the State of California.
Experience: Four years of full-time experience as a Registered Nurse in a managed care, acute care facility, mental health facility, or community health agency setting that includes a minimum of one year of experience in Case Management and Utilization Review.
Option II:
Education: Graduation from an accredited college or university with a bachelor's degree in nursing.
Experience: Three years of full-time experience as a Registered Nurse in a managed care, acute care facility, mental health facility, or community health agency setting that included experience in Case Management and Utilization Review.
Option III:
Education: Graduation from an accredited college or university with a master's degree in nursing.
Experience: Two years of full-time experience as a Registered Nurse in a managed care, acute care facility, mental health facility, or community health agency setting that included experience in Case Management and Utilization Review.
All Options:
Knowledge of: Case management and utilization review principles and practices; payor source documentation requirements and governmental regulations affecting reimbursement, managed care, and healthcare issues and standards; application of the nursing process; full range of Registered Nurse duties and responsibilities; community resources available to provide patient care and follow-up; federal, state and local laws and regulations governing professional aspects of nursing; principles and methods of supervision and training; problem solving techniques.
Ability to: Plan, organize, supervise, and evaluate nursing services on specific unit(s); communicate effectively; positively manage change and conflict; interpret licensure and accreditation standards; analyze and draft department policies and procedures; apply productive problem-solving skills; write clear and concise reports; perform Registered Nurse or public health nurse responsibilities according to the State of California Nursing Practice Act; implement the nursing process.
Education: Successful completion of the coursework required to obtain a valid license to practice as a Registered Nurse in the State of California.
Experience: Four years of full-time experience as a Registered Nurse in a managed care, acute care facility, mental health facility, or community health agency setting that includes a minimum of one year of experience in Case Management and Utilization Review.
Option II:
Education: Graduation from an accredited college or university with a bachelor's degree in nursing.
Experience: Three years of full-time experience as a Registered Nurse in a managed care, acute care facility, mental health facility, or community health agency setting that included experience in Case Management and Utilization Review.
Option III:
Education: Graduation from an accredited college or university with a master's degree in nursing.
Experience: Two years of full-time experience as a Registered Nurse in a managed care, acute care facility, mental health facility, or community health agency setting that included experience in Case Management and Utilization Review.
All Options:
Knowledge of: Case management and utilization review principles and practices; payor source documentation requirements and governmental regulations affecting reimbursement, managed care, and healthcare issues and standards; application of the nursing process; full range of Registered Nurse duties and responsibilities; community resources available to provide patient care and follow-up; federal, state and local laws and regulations governing professional aspects of nursing; principles and methods of supervision and training; problem solving techniques.
Ability to: Plan, organize, supervise, and evaluate nursing services on specific unit(s); communicate effectively; positively manage change and conflict; interpret licensure and accreditation standards; analyze and draft department policies and procedures; apply productive problem-solving skills; write clear and concise reports; perform Registered Nurse or public health nurse responsibilities according to the State of California Nursing Practice Act; implement the nursing process.
Other Requirements for Level I and II:
License: Must maintain a current, valid license to practice as a Registered Nurse in the State of California.
A valid Basic Life Support (BLS) certification issued by the American Heart Association.
Possession of a valid California Driver's License may be required.
Additional Requirement for Health System Nurse Case Manager II:
Certificate: Must maintain a current and valid Case Manager Certificate.
Additional Information
Application StatusHow to confirm your application was received or check on the status of your application, log-in to www.GovernmentJobs.com, click on your name in the upper right corner, and click on “Applications & Status.”
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Go to www.RC-HR.com, click on “Careers,” click on “County Job Openings,” and click on “Subscribe to Job Alerts” icon.
For questions regarding this recruitment,
Please contact Lisette Jimenez at 951-955-5561 or lijimenez@rivco.org. Please allow 1-2 business days for a response to general inquiries.
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