RN- ED Case Management (Utilization Review)

• Job Title: RN ED Case Manager
• Location: Bakersfield, CA 
• Contract Length: 13 Weeks (Extension likely)
• Shift: Night Shift 7p-7:30a/ 11p-7:30a Working 3 – 12hr shifts 1 week AND 3 - 12hr shift + 1 - 8hr shift the next week
• Local Pay: $70–$80/hour (W2) – Negotiable
• Travel Weekly Gross: $2,800 – $3,300
  Stipends: Available for candidates residing 50+ miles from the facility

• Review inpatient admissions and ongoing stays to determine medical necessity and appropriate level of care using InterQual guidelines
• Obtain, evaluate, and manage medical records to ensure required documentation is complete and payor-compliant
• Initiate Physician Advisories for unwarranted admissions or care deviations
• Conduct continued stay reviews and collaborate with attending physicians on care plan changes
• Develop, document, and coordinate comprehensive discharge plans
• Serve as a utilization and reimbursement subject-matter expert for providers and clinical teams
• Identify payor issues and coordinate referrals to appropriate financial or social services
• Coordinate with admitting, clinic, and surgical scheduling teams to prevent inappropriate admissions and unauthorized procedures
• Review and approve elective surgery schedules to confirm authorization and coverage
• Coordinate care and authorization needs involving correctional facilities, including elective procedures and DME
• Educate providers on documentation standards to maximize reimbursement and audit readiness
• Assist with training and mentoring Utilization Review Nurse I staff (Level II scope)

• Active Registered Nurse (RN) license in the State of California
• BLS (AHA Healthcare Provider) certification (or obtain within 60 days of hire)
• Utilization Review experience using InterQual guidelines
• Minimum 1 year of Utilization Review experience in an acute care setting

Experience Pathways:

• Level I: 
  2 years acute care RN experience, including at least 1 year in Medical/Surgical nursing
• Level II (Required for this role):
  1 year utilization review and/or discharge planning experience in an acute care hospital OR 2 years of case management experience in a clinic or physician office performing utilization review or discharge planning

• 1 year of Emergency Department Case Management experience