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 Management
Duration: 13 weeks
Shift: Day 5x8-Hour
Hours per Shift: 8
Experience: 5 years required in acute hospital and long-term care settings
License: State License required
Certifications: BLS, BSN required
Must-Have:
- Epic documentation experience
- InterQual documentation experience
- Experience with admission criteria, care coordination, and discharge planning
- Knowledge of UR (Utilization Review) processes including appeals, denials, concurrent reviews, and retrospective reviews
- Familiarity with CMS guidelines, CPT coding, DRG, HEDIS measures, HIPAA guidelines, ICD 10 coding, and NCQA standards
Description:
We are seeking a Case Manager and Utilization Review RN specializing in cancer care.
Candidates must have a minimum of 5 years of experience in acute hospital settings or long-term acute care, rehabilitation, or skilled nursing facilities.
Experience with Epic and InterQual documentation is essential.
Candidates will be responsible for managing the utilization review process, ensuring compliance with medical necessity and admission criteria.
Key responsibilities include care coordination, discharge planning, and adherence to regulatory guidelines.
Weekend shifts are required for this position.
Successful candidates will demonstrate effective communication using SBAR techniques and have knowledge of revenue cycle processes.
Candidates must possess the necessary certifications and a valid state nursing license upon application.