TravelNurseSource is working with Cynet Health to find a qualified Case Manager RN in Irvine, California, 92618!
Job Title: Case Manager and Utilization Review RN
Profession: Registered Nurse
Specialty: Case Manager
Duration: 13 weeks
Shift: Day
Hours per Shift: 8 hours
Experience: 5 years required
License: State License required
Certifications: BLS, BSN
Must-Have:
Acute Client experience
Long Term Acute Care/Rehab/Skilled Nursing experience
Epic documentation experience
InterQual documentation experience
Description:
Case Manager and Utilization Review RN for Cancer Specialty Client.
Five years of experience is required.
Utilize Epic and InterQual documentation.
SBAR communication is essential.
Weekends are required.
BLS, BSN, and State License are mandatory certifications.
Skills and experience required include:
Acute Client experience.
Understanding of Long Term Acute Care/Rehab/Skilled Nursing.
Knowledge of Admission Criteria.
Care Coordination expertise.
Discharge Planning abilities.
Application of InterQual Criteria.
Utilization of Milliman Guidelines.
Understanding of UR Admission Criteria.
Experience with UR Appeals and Denials.
UR Concurrent Review experience.
UR Continued Stay Reviews knowledge.
UR Medical Necessity expertise.
UR Retrospective Review experience.
Understanding of CMS guidelines.
Familiarity with CPT coding and billing.
Knowledge of the Department of Health regulations.
Understanding of DRG (Diagnosis Related Groups).
Familiarity with HEDIS measures.
Knowledge of HIPAA guidelines.
Experience with ICD 10 coding.
Awareness of NCQA standards.
Understanding of OSHA regulations.
Knowledge of The Joint Commission Core Measure/National Safety Goals.
Understanding of Workers Compensation regulations.