RN Utilization Review Case Manager - Workers' Comp

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

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)