Case Manager - Critical Need

Job Title: Case Manager - Critical Need
Location: Santa Clara, CA 95051
Duration: 3 +Months (Possibility of extension)

Shift Time: Day Shift | 08:30 AM to 05:00 PM | 8hr/5 Shift week | Every other weekend & holidays required


Local Pay Range: $90.00/hr on W2
Travel Pay Range: $3,800.31/week (blended rate + stipend $1,957.51)
 
Job Description:
We are urgently seeking an experienced Hospital Case Manager for a critical need assignment in an acute care setting. The ideal candidate must demonstrate strong expertise in Utilization Review (UR) and Discharge Planning, ensuring medically appropriate, cost-effective care while facilitating safe and timely patient transitions across the continuum. This role requires a high level of clinical judgment, collaboration, and regulatory knowledge within a hospital environment.
 
Responsibilities Include:

• Demonstrated experience in both Utilization Review and Discharge Planning.
• Conduct comprehensive Utilization Review to determine medical necessity, level of care, and length of stay.
• Perform proactive and timely Discharge Planning, coordinating post-acute services and resources.
• Collaborate closely with physicians, nursing staff, social workers, and interdisciplinary teams.
• Communicate with payers regarding authorizations, continued stay reviews, denials, and appeals.
• Identify and address barriers to discharge to prevent delays and reduce length of stay.
• Ensure compliance with CMS, Medicare, Medicaid, and payer guidelines, as well as hospital policies.
• Advocate for patients and families while balancing quality outcomes and resource utilization.
• Maintain accurate, timely documentation within the hospital’s case management systems.

 
Required Certifications & Licence:

• Minimum 1 year recent (within the last 3 years) full-time equivalent experience.
• Active RN license (State of California)
• BLS (AHA)