TravelNurseSource is working with Cynet Health to find a qualified Case Manager RN in Irvine, California, 92618!
Job Title: Case Manager Utilization Review RN
Profession: Registered Nurse
Specialty: Case Management
Duration: 13 weeks
Shift: Day
Hours per Shift: 8 hours
Experience: 5 years
License: Required State License
Certifications: BLS, BSN
Must-Have:
- Acute hospital experience
- Epic and InterQual documentation expertise
- SBAR communication skills
Description:
We are seeking a Case Manager and Utilization Review RN for a specialized position.
The candidate must have at least 5 years of experience in acute hospital settings.
Additional experience in Long Term Acute Care, Rehabilitation, or Skilled Nursing is preferred.
The role requires familiarity with admission criteria, care coordination, and discharge planning.
Utilization of InterQual Criteria and Milliman Guidelines is essential.
Experience with UR admission criteria, UR appeals and denials, and continued stay reviews is required.
A strong understanding of medical necessity and retrospective reviews is necessary.
Knowledge of CMS guidelines, CPT coding, ICD 10 coding, and DRG classifications is essential.
The candidate should be well-versed in HEDIS measures, HIPAA guidelines, and NCQA standards.
Understanding of OSHA regulations and The Joint Commission standards is important.
Weekends will be required, so flexibility is a must.
Preferred certifications include Chemotherapy certification, although it is not mandatory for this role.
The candidate must have a passion for patient care and a commitment to quality in healthcare services.