Case Management Nurse

Accede Solutions Inc (accedesolution.com); West Hollywood (CA); Presencial; USD 83.000 - 96.000; Jornada completa

Descripción de la vacante

Accede Solutions Inc. is seeking a Registered Nurse (RN) case manager for a West Hollywood, CA assignment.

The role focuses on coordinating patient care, developing care plans, and ensuring appropriate utilization and discharge planning within CMS and HIPAA guidelines. The position runs for 13 weeks with a strong possibility of extension, requires a CA RN license, active BLS, and at least two years of acute care case management experience.

Formación

• Active California RN license
• Minimum 2 years acute care case management experience
• CA CM experience; at least 6 months acceptable
• Current BLS certification
• Flu vaccination required; no exemptions
• Strong knowledge of care coordination, discharge planning, and utilization review
• Ability to work the day shift and maintain a flexible schedule

Responsabilidades

• Coordinate patient care with physicians, nurses, social workers and other health professionals
• Develop and implement individualized patient care plans
• Perform utilization review and evaluate medical necessity of care
• Apply InterQual criteria and Milliman guidelines for utilization management
• Ensure CMS regulations, HIPAA and healthcare standards compliance
• Review patient records to support appropriate care delivery
• Coordinate transportation and resources for safe patient discharge
• Support efficient patient transitions across healthcare settings

Conocimientos

RN license

Acute care case management

CA CM experience

BLS certification

Flu vaccination

Care coordination

Discharge planning

Utilization review

Flexible schedule

Herramientas

Epic EMR

Descripción del empleo

Registered Nurse (RN) – Case Manager in West Hollywood, CA

Contract Duration: 13 Week with strong possibility of extension

Shift: Days, 5x8-hour shifts

Schedule: 8:00 AM – 5:00 PM

Experience Required: Minimum 2 years

Certification: BLS

Key Responsibilities:

• Coordinate patient care and collaborate with physicians, nurses, social workers, and other healthcare professionals.
• Develop and implement individualized patient care plans.
• Perform utilization review and evaluate the medical necessity of care.
• Apply InterQual criteria and Milliman guidelines for utilization management.
• Ensure compliance with CMS regulations, HIPAA, and other applicable healthcare standards.
• Review patient records and documentation to support appropriate care delivery.
• Coordinate transportation and other resources required for safe patient discharge.
• Support efficient patient transitions across healthcare settings.

Required Qualifications:

• Active California RN license in hand at the time of submission.
• Minimum 2 years of acute care case management experience.
• Previous California case management experience; at least 6 months is acceptable.
• Current BLS certification.
• Flu vaccination is mandatory; no exemptions are accepted.
• Strong knowledge of care coordination, discharge planning, and utilization review.
• Ability to work the assigned day shift and maintain a flexible schedule.

Preferred Qualifications:

• Epic electronic medical records (EMR) experience.
• Experience in a teaching hospital or community hospital.
• Knowledge of InterQual criteria and Milliman guidelines.
• Familiarity with CMS regulations, DRG, ICD-10, and healthcare compliance standards.
• Shift: Day shift, Monday through Friday, 8:00 AM–5:00 PM.
• Weekend Coverage: Every other weekend, as specified in the unit details; confirm the final schedule with the facility.
• Floating: Not required.
• On-Call: Not required.
• Scheduling Requests: Not accommodated.