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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 Manager (Utilization Review)
- Location: Bakersfield, CA
- Duration: 13 weeks (Possibility of extension)
- Shift Time: Day Shift | 08:30 AM – 05:00 PM
- Local Pay Range: $70/hr - $80/hr - W2
- Travel Pay Range: $3,000/week - $3,700/week (stipend available if >50 miles)
Key Responsibilities:
- Review inpatient medical records to ensure appropriate documentation and medical necessity for admissions and continued stay.
- Conduct concurrent reviews and coordinate with attending physicians regarding patient care and discharge plans.
- Initiate Physician Advisories for questionable or unwarranted admissions.
- Develop, document, and implement discharge plans in coordination with multidisciplinary teams.
- Collaborate with hospital departments to ensure efficient resource utilization and compliance with reimbursement requirements.
- Identify pay source issues and facilitate referrals for financial authorization or assistance.
- Coordinate elective procedure approvals and review surgery schedules for authorization compliance.
- Communicate with correctional facilities, clinics, and payors regarding medical necessity, prior authorizations, and documentation requirements.
- Stay current on payor source regulations, reimbursement guidelines, and clinical best practices.
- Educate healthcare providers and staff on documentation standards to support reimbursement and compliance.
- Mentor and assist Utilization Review Nurse I team members as needed.
- Perform additional duties as assigned.
Preferred Experience:
- Previous experience in California hospitals (more than one assignment preferred).
- Skilled in both Utilization Review and Care Coordination/Discharge Planning.
- Background in acute care, ICU, or Emergency Department settings.
- Experience in trauma or teaching facilities is a strong plus.
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