RN-Case Management (Utilization Review)

• Job Title: RN – Case Management (Utilization Review) – Travel Assignment
• Location: Bakersfield, CA
• Shift: 8hr Days - 40hr/ week
• Contract: 13 weeks
• Pay Range: $70/hr – $85/hr (Stipends Included)

Position Overview

We are seeking experienced Registered Nurses (RN) with strong Case Management and Utilization Review backgrounds for travel assignments in California. This role involves comprehensive utilization review, discharge planning, and care coordination to ensure efficient use of hospital resources while supporting quality patient outcomes.

Key Responsibilities

• Conduct utilization reviews for inpatient admissions; ensure required documentation is present and compliant with payor standards.
• Collaborate with physicians and care teams on discharge planning and transitions of care.
• Initiate Physician Advisories for unwarranted admissions and coordinate with admitting offices to prevent inappropriate admissions.
• Review surgery schedules, authorize elective procedures, and ensure payor approval.
• Work with correctional facilities and community resources on appropriate care utilization.
• Educate providers on payor documentation requirements to maximize reimbursement.
• Provide consultation across departments to optimize resource utilization.
• Mentor and assist training for Utilization Review Nurse I staff as applicable.

Required Qualifications

• Active California RN license (required).
• Level I: 2 years acute care RN experience (including 1 year in medical/surgical).
• Level II: 1 year utilization review/case management experience in acute care OR 5 years in an alternate setting (clinic/physician office).
• BLS certification (AHA) – must be obtained within 60 days if not current.
• Background in both utilization review and care coordination/discharge planning.
• Experience in acute care, ICU, or ED settings.
• Exposure to trauma facilities and teaching hospitals