RN Case Management

Job Title: RN Case Management (Utilization Review) - ONSITE
Location: Bakersfield, CA 93306
Contract Length: 13 Weeks (High likelihood of extension)
Schedule: Day Shift | 8 Hours | 5 Days/Week

We’re seeking an experienced Registered Nurse – Case Management (Utilization Review) to operate at a fully independent level, driving utilization review and discharge planning workflows. This role is mission-critical in optimizing patient care delivery while ensuring compliance with payer requirements and maximizing reimbursement integrity.

• Perform comprehensive utilization review for inpatient admissions to validate medical necessity and documentation accuracy
• Collaborate with physicians to address admission appropriateness and initiate advisories when needed
• Conduct ongoing case reviews and recommend care plan adjustments
• Develop and execute discharge plans to ensure smooth transitions of care
• Coordinate with interdisciplinary teams to ensure efficient resource utilization
• Identify and resolve payor-related issues, ensuring proper authorizations and reimbursements
• Review and approve elective procedures and surgical schedules for authorization compliance
• Liaise with external providers and agencies for tests, services, and care coordination
• Educate providers on documentation standards to optimize reimbursement outcomes
• Support training and mentorship of junior utilization review staff

• Active California RN License
• Minimum 2 years RN experience in acute care, including:
  • At least 1 year in Med/Surg
• Plus one of the following:
  • 1 year utilization review/discharge planning experience in acute care
    OR
  • 2 years Case Management experience in clinic or physician office setting

• Strong knowledge of payor requirements, reimbursement guidelines, and regulatory compliance
• Solid foundation in acute care nursing practices and disease processes
• Ability to evaluate medical necessity, level of care, and discharge readiness
• Skilled in cross-functional communication with physicians and healthcare teams
• Analytical mindset with ability to review data and drive actionable insights
• Strong documentation and provider education capabilities

• Prior California travel assignments (multiple assignments preferred)
• Experience in acute care settings (ICU/ED)
• Exposure to trauma centers or teaching hospitals
• Ability to handle both Utilization Review + Care Coordination/Discharge Planning