Registered Nurse (RN) – Case Manager (Utilization Review)

Job Title: Registered Nurse (RN) – Case Manager (Utilization Review)
Location: Santa Clara, CA - 95051
Duration: 3 Months+ (Possibility of extension)

Shift Time: Day Shift | 08:30 AM – 05:00 PM
Local Pay Range: $60 - $70/hr. on W2
Travel Pay Range: $2,500/week - $3,000/week (stipend available if >50 miles)

Overview:
We’re seeking an experienced Registered Nurse – Case Manager (Utilization Review) to join a leading healthcare facility in Santa Clara. This role focuses on ensuring appropriate utilization of healthcare resources, coordinating patient care plans, and supporting quality outcomes through effective case management practices.

Key Responsibilities:

• Conduct utilization reviews to ensure compliance with medical necessity and payer requirements.
• Collaborate with physicians, interdisciplinary teams, and insurance providers for care coordination.
• Develop and manage patient care plans to promote safe, timely discharges.
• Maintain accurate documentation and adhere to all hospital and regulatory guidelines.

Qualifications:

• Active California RN License (unrestricted).
• Minimum 1 years of recent Utilization Review or Case Management experience.
• Strong knowledge of payer systems, discharge planning, and regulatory standards.
• Excellent communication, critical thinking, and organizational skills.