RN - Case Manager

Cynet HealthStaff; Orange (CA); Hybrid; USD 83,000 - 117,000; Full time

Job summary

Cynet HealthStaff is seeking an RN Case Manager for a 13-week, day-shift contract in California. The role requires hands-on utilization review, medical necessity determinations, and proficiency with EPIC and InterQual.

The position is in-person with a possibility to work remotely part-time, Monday through Friday with no weekends or major holidays. Candidates should have at least 1 year of UR experience and a valid CA nursing license.

Qualifications

• Proficiency in EPIC and InterQual for clinical reviews.
• Experience in clinical review and medical necessity determination.
• CPI Blue Card required for ER nurses.

Responsibilities

• Perform clinical reviews and determine medical necessity.
• Coordinate utilization review for patient cases.
• Maintain EPIC documentation and InterQual criteria.
• Collaborate with hospital teams on admissions and discharges.

Skills

Clinical review

Medical necessity

Charge experience

Education

RN license (CA)

Tools

EPIC

InterQual

Job description

RN - Case Manager

Profession: Nursing

Specialty: Utilization Review

Duration: 13 weeks

Shift: Day

Hours per Shift: 8 hours

Experience: Minimum of 1 year in utilization review

License: Valid state nursing license required

Certifications: All required certifications must be in-hand when applying.

Must-Have:

• Proficiency in EPIC and InterQual.
• Experience in clinical review and medical necessity determination.
• CPI Blue Card from the Crisis Prevention Institute required for all emergency room nurses.

Description:Candidates must be highly proficient in EPIC and InterQual.Demonstrated experience using both systems for clinical review and medical necessity determination is required.This position is in person with the possibility to be remote, Monday through Friday, with no weekends or holidays.Pre-approved time off is allowed but cannot exceed five days.Shift times can start between 8 or 9 AM, depending on candidate availability.All required certifications must be in hand when applying.Previous charge experience and community hospital experience are preferred.Experience with acute hospital admission criteria, continued stay reviews, and medical necessity is required.References from two supervisors are required when applying.Local candidates will be considered.Candidates must be prepared for the possibility of no interview with the manager.Epic experience must be noted in the candidate’s work history.