Initial Clinical Reviewer- RN Case Manager

Intelligent Medical Solutions - IMS; Lake Forest (CA); On-site; USD 80,000 - 90,000; Full time

Benefits offered by this job

Benefits package

Employer-matched 401(k)

Professional development

Fully equipped workstation

Job summary

Intelligent Medical Solutions (IMS) is seeking an RN Utilization Review Case Manager to evaluate and authorize care for injured workers on-site in Lake Forest, CA. Perform prospective, concurrent, and retrospective reviews, ensure compliance with state UR guidelines, and deliver clear, evidence-based review reports while mentoring junior staff.

Requires active RN license, 3+ years of clinical nursing, 3+ years in Workers' Compensation, 2+ years in Utilization Review; benefits include 401(k)

Qualifications

• Graduate of an accredited School of Nursing with an active, unrestricted RN license.
• 3+ years of clinical nursing experience.
• 3+ years in Workers Compensation.
• 2+ years in Utilization Review (CPT, HCPCS familiarity).
• 2+ years in IT-adjacent clinical roles (e.g., Data Analyst, CDI).
• Proficient with MS Office and case management systems.

Responsibilities

• Clinical Evaluations: perform prospective, concurrent, and retrospective utilization reviews per state guidelines.
• Care Authorizations & Escalations: authorize medically necessary treatments or package cases for physician review.
• Compliance & Quality: maintain compliance with state turnaround times and UR regulations.
• Professional Communication: deliver high-quality review reports and clear clinical communications.
• Team Collaboration & Leadership: participate in committees and mentor junior reviewers.

Skills

RN clinical nursing

Strong clinical judgment

Clear communication

Education

RN license

Bachelor of Science in Nursing (BSN)

Tools

MS Office

Case management system

Clinical data tracking

Job description

Location: Lake Forest, CA (100% On-Site)

Salary: $80,000 - $90,000 / year + Comprehensive Benefits

Job Type: Full-Time

Why Join Intelligent Medical Solutions (IMS)?

At IMS, we blend clinical expertise with smart technology to drive exceptional medical management outcomes. As an RN Utilization Review Case Manager, you won't just review cases—you'll serve as a critical decision-maker ensuring injured workers receive proper, evidence-based care while keeping medical systems compliant and efficient.

We provide top-tier benefits, employer-matched 401(k), professional development opportunities, and fully equipped workstations (monitors, computers, and tech set up for success).

Key Responsibilities

• Clinical Evaluations: Perform prospective, concurrent, and retrospective utilization reviews using state-specific Workers Compensation guidelines and evidence-based clinical criteria.
• Care Authorizations & Escalations: Authorize medically necessary treatment requests or package complex cases with clear clinical rationales for physician review.
• Compliance & Quality: Maintain strict compliance with state turnaround times, state-specific UR regulations, and internal quality standards.
• Professional Communication: Deliver clear, high-quality review reports and field clinical calls with professional authority and clear rationale.
• Team Collaboration & Leadership: Participate in department committees and mentor junior clinical reviewers to help elevate team standards.

What You Need to Succeed

Required:

• Education & License: Graduate of an accredited School of Nursing with an active, unrestricted RN license.
• Clinical Background: 3+ years of clinical nursing experience.
• Specialized Experience:
• 3+ years in Workers Compensation.
• 2+ years in Utilization Review (familiarity with CPT, HCPCS, Carve-outs, and Bill Review).
• 2+ years in IT-adjacent clinical roles (e.g., Data Analyst, Clinical Documentation Improvement / CDI).
• Technical Skills: High proficiency with MS Office (Excel, Word), case management systems, and clinical data tracking.
• Core Strengths: Ability to thrive in a high-volume, deadline-driven environment with minimal supervision and strong clinical judgment.

Preferred:

• Bachelor of Science in Nursing (BSN) or related degree.
• Healthcare: Health, Dental, and Vision Insurance
• Financial Security: 401(k) with Employer Matching, Health Savings Account (HSA), and Flexible Spending Account (FSA)
• Work-Life Balance: Generous Paid Time Off (PTO) and Flexible Scheduling options
• Growth & Support: Education Assistance Opportunities & full company-provided hardware setup