Health System Nurse Case Manager I/II - RUHS Medical Center - Utilization Review/Case Management

Health System Nurse Case Manager I/II - RUHS Medical Center - Utilization Review/Case Management

Salary

$108,929.60 - $179,878.40 Annually

Location

Moreno Valley

Job Type

Regular

Job Number

26-74061-01-DD

Department

RUHS-Medical Center

Division

UR-Case Management

Opening Date

09/16/2026

Closing Date

9/20/2026 11:59 PM Pacific

• Description
• Benefits
• Questions

For questions regarding this position, please contact the Recruiter listed in the Supplemental Information section.

ABOUT THE POSITION

The County of Riverside - Riverside University Health System-Medical Center is seeking highly skilled and experienced Registered Nurses to join their team as a Health System Nurse Case Manager with the UR Case Management Department.

Work Schedule:

Six (6) 12-hour shifts, 7:00 PM-7:30 AM, and one (1) 8-hour shift, 11:00 PM-7:30 AM.

The level at which the position will be filled is at the discretion of the department.

Salary Range:

Health System Nurse Case Manager I: - $52.3749 - $81.0634

Health System Nurse Case Manager II: $57.3800 - $86.4850

Meet the Team!

Founded in 1893, Riverside University Health System Medical Center has grown into a cornerstone of healthcare excellence and medical education in the region. Our highly skilled healthcare professionals and dedicated support staff are committed to delivering exceptional, state-of-the-art care to the diverse populations of Riverside County.

Located in Moreno Valley, our 439-bed Medical Center is home to a Level I Trauma Center, a Level II Pediatric Trauma Center, and the county's only Pediatric Intensive Care Unit (PICU). If you're passionate about making a meaningful difference and helping others, RUHS Medical Center is the place for you!

For more information about RUHS Medical Center, please visit www.ruhealth.org

EXAMPLES OF ESSENTIAL DUTIES

• 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.
• May testify in court as to the clients mental and physical condition.

MINIMUM QUALIFICATIONS

Health System Nurse Case Manager 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: 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 bachelors degree from an accredited college or university in nursing may substitute for one year of the required experience.)

Health System Nurse Case Manager II:

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 bachelors 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 masters 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.

Must possess a valid Basic Life Support (BLS) certification issued by the American Heart Association for professional healthcare providers.

Additional Requirement for Health System Nurse Case Manager II:

Certificate: Must maintain a current and valid Case Manager Certificate.

SUPPLEMENTAL INFORMATION

Application Status

How 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."

Sign Up for Job Alerts

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:

Contact Denise DeCamp at (951) 955-0196 or ddecamp@rivco.org. Please allow 1-2 business days for a response to general inquiries.

____

APPLICATION INFORMATION

Veterans Preference

The County has a Veterans Preference Policy applicable to new hires. To qualify, attach the required documents to your job application. Documents include a copy of your (or your spouses) Member-4 Form DD-214 indicating dates of service. For spousal preference, and as applicable, the following documents: a copy of your marriage certificate, spouses death certificate, a letter of spouses disability and/or letter of service-related death (if available) from the U.S. Veterans Administration. For privacy reasons, it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans preference. For complete details and documentation requirements, please review the Veterans Preference Policy, C-3 here: https://rivcocob.org/board-policies

Reasonable Accommodations

The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation, please visit the Disability Access Office web page located at: https://rc-hr.com/disability

Work Location and Telework

In-person attendance is the standard work expectation for County of Riverside assignments. Certain assignments may be eligible for a hybrid telework schedule; however, telework arrangements are subject to management approval, operational needs, and/or may be modified or discontinued at any time. Employees who telework are expected to be able to report to their assigned worksite on short notice or as operational needs require. Unless otherwise specified for a particular position, employees are expected to reside in California following appointment. Limited exceptions may apply. Applicants should contact the assigned recruiter for additional information regarding work location expectations, telework eligibility, and residency requirements.

Proof of Education

If using education to qualify or when requested by the recruiter, upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.

If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services (NACES) or Association of International Credential Evaluators, Inc. (AICE).

Work Authorization Requirement

Applicants must be legally authorized to work in the United States at the time of application. The County of Riverside does not participate in visa sponsorship programs, including H1-B visas, and will not provide sponsorship for any employment-based visas.

Equal Opportunity Employer

The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition (cancer and genetic characteristics), genetic information, or denial of medical and family care leave, or any other non-job-related factors.

Pre-Employment

All employment offers are contingent upon successful completion of pre-employment requirements including a criminal background investigation, which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A pre-employment physical examination and background check may be required.

Probationary Period

As an Approved Local Merit System, all County of Riverside employees, except those serving "At Will," are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding, County Resolution, or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.

General Information

Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies.

Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume, as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.

Please read and follow any special application instructions on this posting. Click the Apply link located on this page to submit your application. For additional instructions on the application process, examinations, Veterans preference, pre-employment accommodation or other employment questions, please refer to our web site, www.rc-hr.com.

If you are experiencing technical problems, you may contact the governmentjobs.com applicant support desk Monday through Friday, 6 am to 5 pm Pacific Time at support@governmentjobs.com or toll-free 1-855-524-5627.

BENEFIT PROGRAM: SEI

MEDICAL/DENTAL/VISION INSURANCE: A choice of different medical, dental and visions plan are available to elect. The County provides a Flexible Benefit Credit contribution as governed by the applicable SEIU Memorandum of Understanding to contribute towards the cost of these plans.

Note: Employees on assignment through the Temporary Assignment Program (TAP) receive different benefits. See the list here.

MISCELLANEOUS RETIREMENT: County of Riverside has three retirement Tiers through the California Public Employees Retirement System (CalPERS).

• Tier I (Classic Member - Formula 3% @ 60): Applicable to current and former County of Riverside local miscellaneous employees hired prior to 08/24/2012 and did not withdraw CalPERS contributions. The employee contribution is eight (8%) percent.
• Tier II (Classic Member - Formula 2% @ 60): Applicable to local miscellaneous employees 1) hired after 08/23/2012 through 12/31/2012; 2) Previously employed with another CalPERS contracting public agency or a reciprocal retirement system, with a break in service of less than six months between the separation date with the previous employer and the appointment date with the County of Riverside. The employee contribution is seven (7%) percent.
• Tier III (PEPRA New Member - Formula 2% @ 62): Applicable to CalPERS local miscellaneous new members hired on or after the implementation of the Public Employees Pension Reform Act of 2013 (PEPRA) which took effect January 1, 2013. Effective July 1, 2023 employee contributions are 7.25% and will increase to 7.75% effective July 1, 2024.

A new member is defined as any of the following:

• A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who has no prior membership in any California Public Retirement System.
• A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who was a member with another California Public Retirement System prior to that date, but who is not subject to reciprocity upon joining CalPERS.
• A member who first established CalPERS membership prior to January 1, 2013, and who is rehired by a different CalPERS agency after a break in service of greater than six (6) months.

CalPERS refers to all members that do not fit within the definition of a new member as "classic members".

Contribution rates are subject to change based on the County of Riverside annual actuarial valuation.

Note:

This summary is for general information purposes only. Additional questions regarding retirement formulas can be sent to retirement@rivco.org or by calling the Benefits Information Line at (951) 955-4981,

Option 2.

If you have prior service credit with another CalPERS agency or within agencies, please contact CalPERS at (888) 225-7377 to determine which retirement tier would be applicable to you. CalPERS is governed by the Public Employees Retirement Law. The Retirement Law is complex and subject to change. If theres any conflict between this summary and the law, the law will prevail over this summary.

DEFERRED COMPENSATION: Voluntary employee contribution with a choice between two 457 deferred compensation plan options.

VACATION ACCRUAL (Bi-Weekly Accrual):

0 < 3 year = 80 Hours (10 Days)

4 < 9 years = 120 Hours (15 Days)

10 or more years = 160 Hours (20 Days)

Maximum Vacation leave accumulation is 480 hours.

SICK LEAVE: Four (4) hours Sick Leave accrual per pay period with unlimited accrual.

HOLIDAYS: Normally 12 paid holidays per year.

BEREAVEMENT LEAVE: Allowed 5 days (3 days are County paid; 2 additional days can be taken from accrued Sick Leave balance).

BASIC LIFE INSURANCE: Equal to one times annual base salary not to exceed $50,000 of term life coverage. Premiums are paid by the County. Additional Supplemental Life plan is available for employee purchase.

DISABILITY:

Employees contribute to State Disability Insurance (SDI), which provides wage replacement benefits for individuals who are unable to work due to non-work-related illness, injury, or pregnancy. SDI also includes Paid Family Leave Benefits. The wage replacement rate is determined by current law, offering 60-70% of the wages earned during the SDI eligibility period.

Additionally, employees receive employer-paid Long-Term Disability Benefits, which cover 66.67% of pre-disability earnings, up to a maximum of $10,000 per month. There is a 365-day waiting period before these benefits become active. Employees may coordinate these benefits with other available leave balances to receive up to 100% of their regular pay.

POST RETIREMENT MEDICAL CONTRIBUTION: A monthly contribution is made by the County towards retiree health insurance offered through the County as governed by the applicable SEIU Memorandum of Understanding.

OTHER: There may be other benefit provisions as specified in the applicable Memorandum of Understanding. Please contact the recruiter listed on the job posting directly for more information.

01

Do you possess a current, valid license to practice as a Registered Nurse in the state of California?

• Yes
• No

02

Please provide your Registered Nurse Licensure Number.

03

Are you a current or per diem employee with the Riverside University Health System (RUHS) - Medical Center?

• Yes
• No

04

What is your highest level of education from an accredited college or university in Nursing?

• None
• I have my Associate Degree in Nursing (ADN)
• I have my Bachelor of Science in Nursing (BSN)
• I have my Master of Science in Nursing (MSN)
• I have my Doctorate Degree in Nursing (DNP)

05

Do you have a current Basic Life Support (BLS) Certification issued by the American Heart Association?

• Yes
• No

06

How many years of experience do you have working as a Registered Nurse in an acute care facility, mental health facility or community health agency?

• None
• Less than 12 months
• 1 year, but less than 2 years
• 2 years, but less than 3 years
• 3 years, but less than 4 years
• 4 years, but less than 5 years
• 5 years or more

07

How many years of full-time experience do you have as a Licensed Vocational Nurse working in an acute care setting within a hospital setting?

• None
• 1 year of LVN experience
• 2 years of LVN experience
• 3 years of LVN experience
• 4 years of LVN experience
• 5 years of LVN experience
• 6 years or more

08

How many years of full-time experience do you have in medical case management, discharge planning and/or utilization review?

• None
• Less than 12 months
• 1 year, but less than 2 years
• 2 years, but less than 3 years
• 3 years, but less than 4 years
• 4 years, but less than 5 years
• 5 years, but less than 6 years
• 6 years or more

09

Do you currently hold a Case Manager Certification (CCM)?

• Yes
• No

10

Do you have experience with InterQual criteria to assess medical necessity and determine the appropriate level of care for patients?

• Yes
• No

11

How many years of experience do you have using EPIC - Electronic Health Record (EHR) system?

• None
• 1 year or more, but less than 2
• 2 years or more, but less than 3
• 3 years or more, but less than 4
• 4 years or more, but less than 5
• 5 years or more

12

Are you willing and able to work night shifts (Hours: 7:00 pm to 7:30 am)?

• Yes
• No

13

Are you willing and able to work weekends and holidays as required?

• Yes
• No

Required Question

Employer County of Riverside

Address County Admin. Center P.O. Box 1569

4080 Lemon St., 7th floor

Riverside, California, 92502-1569

Phone Contact Recruiter for Job Information

Website http://www.rc-hr.com