RN Case Manager — Utilization Review (EPIC/InterQual)

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

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.