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(InterQual) Hospital Case Manager - Registered Nurse (RN)

Job Description

Hospital - RN Case Manager - 40 Hours Per Week

About the Job:  

  • Responsible for the assessment, facilitation, planning and coordination of medical care and services for patients to ensure appropriate treatment in the most cost effective manner
  • Level of Care, Length of Stay, Continued Stay Reviews
  • Coordinating discharge planning with physicians, nursing, and social services, patient and family.
  • Review patient procedures and DRG status against criteria for Medicare, Medi-Cal, and other insurance coverage.
  • Perform chart reviews and quality assessments using severity of illness (SI) and intensity of service (IS) InterQual criteria (and/or Milliman)
  • Process TARS as needed


 Knowledge of:  

  1. DRG and ICD-9 and CPT coding, requirements for prior approval.
  2. Available community resources.
  3. Local Referral Network
  4. Effective charting practices and guidelines.
  5. Reimbursement related to Medicare, Medi-Cal & Managed Care


Job Requirements

  • California Nursing License (RN)


About the Agency:  

Managed Care Resources, Making Careers is a Health Care Staffing Agency in the niche fields of Case Management, Utilization Management / Review, Quality Management / Assurance and Performance Improvement. MCR, Making Careers has been servicing the State of California since 1987 providing Medical Professionals to Hospitals, Medical Groups, IPAs, Health Plans, Healthcare Foundations, Home Health Departments, Medical Offices, Managed Care and Insurance Companies in search of both Permanent and Temporary Staff. Call: (310)-470-4232 or (800)-350-1471 for more information!

Job Snapshot

Employment Type Full-Time
Job Type Health Care, Nurse
Education 2 Year Degree
Experience At least 2 year(s)
Manages Others No
Industry Healthcare - Health Services, Managed Care
Required Travel None
Job ID 14A*
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(InterQual) Hospital Case Manager - Registered Nurse (RN)

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