RN-Case Management (Utilization Review)

Job Title: RN-Case Management (Utilization Review)
Location: Bakersfield, CA - 93306
Schedule: Day
Pay Local: $60/hr - $70/hr - W2
Travel Pay: $3000/week - $3600/week

Key Responsibilities

• Conduct comprehensive medical record reviews for inpatient admissions to ensure appropriate documentation.
• Initiate physician advisories for unwarranted admissions and coordinate with payor agencies as required.
• Collaborate with attending physicians and interdisciplinary teams to manage patient care transitions and discharge planning.
• Develop, document, and implement effective discharge plans to optimize bed utilization.
• Coordinate with admitting and clinic departments to prevent inappropriate admissions and authorize elective procedures.
• Serve as a resource to providers for reimbursement, prior authorization, and payor documentation requirements.
• Evaluate surgery schedules and specialized procedures for appropriate authorization.
• Work closely with correctional facilities on elective procedure approvals and ancillary services.
• Maintain strong knowledge of disease processes, treatment modalities, and evolving payor requirements.
• Level II: Provide training and mentorship to Utilization Review Nurse I team members.

Required Qualifications

• Active Registered Nurse (RN) license in the State of California.
• Level I: Minimum 2 years of acute care hospital experience (including 1 year in Med-Surg).
• Level II: Minimum 1 year of utilization review and/or discharge planning experience in an acute care hospital OR 5 years as a Case Manager in an alternate medical setting.
• Current BLS (Basic Life Support) certification through AHA (or ability to obtain within 60 days of hire).

Preferred Experience

• California healthcare experience with multiple assignments.
• Dual background in Utilization Review and Care Coordination/Discharge Planning.
• Prior work in acute care, ICU, or ED units.
• Experience in Level I or II Trauma Centers and teaching facilities.