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Job Requirements of RN-Case Management (Utilization Review):
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Employment Type:
Contractor
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Location:
Bakersfield, CA (Onsite)
Do you meet the requirements for this job?
RN-Case Management (Utilization Review)
Careers Integrated Resources Inc
Bakersfield, CA (Onsite)
Contractor
- Job Title: RN – Case Management (Utilization Review)
- Location: Bakersfield, CA 93306
- Shift: 8am - 4:30pm (Potential Weekend)
- Contract: 13 weeks
- Local Pay: $70/hr – $80/hr
Key Responsibilities
- Review medical records for inpatient admissions to ensure proper documentation.
- Conduct concurrent reviews and collaborate with physicians regarding patient care changes.
- Initiate Physician Advisories for unwarranted admissions.
- Develop and document discharge plans, coordinating with internal and external providers.
- Identify and resolve pay source problems; make appropriate referrals.
- Coordinate elective surgery schedules to confirm authorization.
- Collaborate with admitting offices, clinics, and correctional facilities to ensure efficient use of services.
- Provide guidance on reimbursement, prior authorization, and documentation requirements.
- Stay current with disease processes, treatment modalities, and payor regulations.
- Educate providers and mentor Utilization Review Nurse I staff as needed.
- Perform other job-related duties as assigned.
Qualifications
- License: Active RN license in the State of California.
- Experience (Level II):
- Minimum 1 year of utilization review or discharge planning experience in an acute care hospital OR
- 5 years of case management experience in a clinic or physician office performing utilization/discharge planning.
- Clinical Background: 2 years of acute care RN experience, with at least 1 year on a med-surg unit (ICU/ED/Trauma experience preferred).
- Certifications: Current American Heart Association BLS required (or obtained within 60 days of hire).
Preferred Experience
- Prior work experience in California (multiple assignments preferred).
- Skilled in both utilization review and care coordination/discharge planning.
- Experience in acute care, ICU, ED, trauma, or teaching facilities.
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