Posting Date: 3/13/2026 Internal Closing Date: 3/19/2026* Internal candidates must apply by midnight on the Closing Date in order to have bidding rights. Responsible for assessing and monitoring appropriate safe discharge plan by promoting quality, cost effective options, and interventions for patients in an acute care setting and as the patient transitions through the continuum of care. Through a collaborative process, participates in interdisciplinary patient rounds in assigned patient care unit with ability to lead discussion and direct plan. Ensures medical appropriateness criteria are met for level of care provided and is documented from admission through discharge. Reevaluates plan of care and ensures continued appropriateness based on the patients changing needs and condition as well as to identify potential delays, determine effectiveness and patient/family satisfaction. Maintains working knowledge of specialized case and utilization management methodologies and practices; applies concepts to everyday practice. Provides decision support for the treatment care team regarding documentation elements required by regulatory agencies and payers, e.g., Medicare, Medi-Cal, Health Plans, and Contracts; helps team understand the interrelationship of reimbursement with efficient and appropriate utilization of resources and service. Maintains working knowledge of specialized case and utilization management methodologies and practices; applies concepts to every-day practice. Completes required continuous training and education, including department specific requirements to maintain current knowledge of department and hospital policies, procedures and billing practices, compliance plans, federal and state regulations , insurance regulations and accrediting body standards concerning the case and utilization management. Understands and adheres to the California Nurse Practice Act, The American Nurses Association (ANA) Code of Ethics for Nurses, the ANA Bill of Rights for Registered Nurses and the ANA Scope and Standards of Practice for Nursing.
Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, Powerpoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.
Minimum Education: As required by certification and/or licensure Preferred Education: Bachelor's Degree and/or National Certification in Utilization Review or Case Management Minimum Experience: 1 - 3 years of directly related RN experience Preferred Experience: 3 - 5 years acute care nursing experience
Completion of Utilization Review/Case Management course Required Certification: American Heart Association recognized BLS - Healthcare Provider Preferred Certification: Not Applicable Required License: Current CA RN License Preferred License: Not Applicable
Established in 1948, the award-winning team at Palomar Health provides the most comprehensive healthcare in North San Diego County through its two medical centers and more than 900 affiliated medical providers serving more than half a million people. Palomar Health is nationally recognized as operating one of America’s 250 Best Hospitals; a Best 100 Hospital for joint replacement and orthopedic surgery; a Best Hospital for stroke care, heart care and bariatric surgery; a Diabetes and Stroke Center of Excellence; and a Blue Distinction Center for spine surgery, cardiac care and maternity.
Through its network of providers, Palomar Health offers medical services in virtually all fields of medicine, including primary care, cardiovascular care, emergency services, trauma, cancer, orthopedics, women’s health, behavioral health, rehabilitation, robotic surgery and bariatric surgery at offices strategically located throughout the North San Diego County region.
