Urgent Hiring for the Position of Medical Case Manager || Orange CA

Job Summary Seeking a licensed Medical Case Manager to support behavioral health utilization management, review medical necessity, coordinate care, and ensure compliance with clinical guidelines and documentation requirements. Key Responsibilities Review inpatient and outpatient requests for medical necessity using established clinical criteria.

Job Title: Medical Case Manager

Duration: Up to 6 Months

Location : Orange CA 92868

Schedule: Monday Friday, 8:00 AM 5:00 PM

Work Arrangement: Fully Onsite

Job Summary

Seeking a licensed Medical Case Manager to support behavioral health utilization management, review medical necessity, coordinate care, and ensure compliance with clinical guidelines and documentation requirements.

Key Responsibilities

• Review inpatient and outpatient requests for medical necessity using established clinical criteria.

• Screen cases for Medical Director review and communicate decisions to providers and members.

• Maintain accurate documentation in utilization management systems.

• Coordinate Transition Care Management (TCM) activities.

• Review ICD-10, CPT, and HCPCS codes for accuracy and coverage.

• Identify utilization concerns, complaints, and authorization updates.

• Support administrative tasks, data tracking, and departmental initiatives.

Requirements

• Current unrestricted California license: LCSW, LPCC, LMFT, or RN.

• Minimum 3 years of clinical experience.

• Utilization Management Reviewer experience required.

• Managed care and behavioral health experience preferred.

• Strong communication, analytical, documentation, and organizational skills.