RN Case Manager – Inpatient Acute Care

Pyramid Consulting, Inc; Santa Clara (CA); On-site; USD 103,320 - 123,984; Full time

Job summary

A leading Healthcare firm seeks an experienced RN Case Manager for an inpatient acute care role in Santa Clara, CA. The position, on a 3-month contract with potential for extension, requires an active RN License in California and at least 2 years of relevant experience. Responsibilities include conducting concurrent reviews and ensuring compliance with CMS standards. This onsite role demands effective collaboration with interdisciplinary teams and offers a competitive pay range of $75 - $90/hour.

Qualifications

• 2+ years of inpatient acute care case management or utilization review experience.
• Experience with InterQual or MCG.
• Acute hospital background required.

Responsibilities

• Conduct inpatient concurrent and continued stay reviews.
• Determine medical necessity and level-of-care decisions.
• Collaborate with case managers and interdisciplinary teams.
• Manage denials and authorizations.
• Ensure compliance with CMS standards.

Skills

Inpatient acute care case management

Utilization review

Knowledge of Medicare / CMS guidelines

InterQual or MCG criteria application

Education

Active California RN License

Job description

Immediate need for a talented RN Case Manager – Inpatient Acute Care. This is a 03+months contract opportunity with long-term potential and is located in Santa Clara, CA (Onsite). Please review the job description below and contact me ASAP if you are interested.

Job ID: 26-04129

Pay Range: $75 - $90/hour. Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)

Key Responsibilities:

• Note; Open to candidates across the United States willing to work onsite in CA
• This is a day-shift, onsite role focused on concurrent review, medical necessity determination, and discharge planning coordination within an acute hospital setting.
• Schedule: 8:00 AM – 4:30 PM
• Duration: 13 Weeks
• 5 days/week including every other weekend (Saturday & Sunday)
• Headcount: 2 Travelers
• Perform inpatient concurrent and continued stay reviews
• Apply InterQual or MCG criteria for medical necessity and level-of-care decisions
• Collaborate with hospital case managers and interdisciplinary teams
• Manage denials, authorizations, and payer communications
• Ensure compliance with CMS and regulatory standards

Key Requirements and Technology Experience:

• Active California RN License (Required prior to start)
• 2+ years of inpatient acute care case management or utilization review experience
• Experience with InterQual or MCG
• Strong knowledge of Medicare / CMS guidelines
• Acute hospital background required

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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