Travel RN - Case Management/Utilization Review - Case Management

American Traveler; Irvine (CA); On-site; USD 100,000 - 140,000; Full time

Benefits offered by this job

High Pay and Bonuses

Medical, Dental and Vision Insurance w

Day 1 Benefits

401(k) Plan

Weekly Payroll Deposit

Free Online CEUs

Generous Housing Allowance

Travel and Licensure Reimbursements

Non-taxed Per Diem and Subsidy

Traveler Rewards and Discounts

Job summary

American Traveler is seeking an experienced RN Case Manager/Utilization Review nurse for a cancer specialty hospital in California. The role requires a CA RN license, a BSN, and at least 5 years of case management/UR experience, including familiarity with InterQual criteria and Milliman guidelines.

The position includes day shift hours with weekend work and local travel considerations. The candidate should have acute hospital, LTAC/rehab/SN, and CMS/HIPAA knowledge, with proficiency in SBAR

Qualifications

• Active CA RN license required, in hand upon consideration
• Minimum 5 years of experience in case management/utilization review
• Acute hospital experience required
• Long Term Acute Care/Rehab/Skilled Nursing experience required
• Familiarity with CMS guidelines and coding concepts

Responsibilities

• Case Management and Utilization Review within a cancer specialty hospital
• Day shift 8:00 AM to 4:30 PM, 5x8 schedule
• Weekend work required
• Coordinate patient care, admissions, and discharge planning
• Conduct utilization reviews including concurrent and retrospective reviews
• Use Epic for documentation and InterQual criteria for UR

Skills

Care coordination

Discharge planning

Utilization review

Admission criteria evaluation

Medical necessity determination

SBAR communication

Regulatory knowledge

EMS and OSHA familiarity

Education

BSN

BLS certification

Tools

Epic

Job description

American Traveler is hiring an experienced RN Case Manager/Utilization Review nurse for a cancer specialty hospital, requiring 5 years of experience and a CA RN license.

Requirements

• Active CA RN license required, in hand upon consideration (no pending license or EMSA accepted)
• BSN required
• BLS certification required
• Minimum 5 years of experience in case management/utilization review required
• Acute hospital experience required
• Long Term Acute Care/Rehab/Skilled Nursing experience required
• Experience with admission criteria, care coordination, and discharge planning required
• Proficiency with InterQual Criteria and Milliman Guidelines required
• Experience with UR admission criteria, appeals and denials, concurrent review, continued stay reviews, medical necessity, and retrospective review required
• Knowledge of CMS, CPT coding, DRG, HEDIS, HIPAA, ICD-10 coding, NCQA, OSHA, and Joint Commission standards required
• Familiarity with Workers Compensation processes required

Responsibilities

• Case Management and Utilization Review role within a cancer specialty hospital setting
• Day shift schedule, 5x8 hours from 8:00 AM to 4:30 PM
• Weekend work required
• Uses Epic for documentation and InterQual criteria for utilization review
• Utilizes SBAR communication method
• Coordinate patient care, manage admissions, and oversee discharge planning within an acute cancer specialty hospital
• Conduct utilization reviews including concurrent and retrospective reviews to ensure medical necessity
• Flu vaccine or signed declination form required during flu season (October-March)
• No restrictive RTO rules for this position
• Local candidates accepted at local rate within a 75-mile radius
• First-time travelers are welcome to apply
• Travel pairs are allowed
• Former employees of this facility will not be considered for this position

Benefits

• High Pay and Bonuses
• Medical, Dental and Vision Insurance with Day 1 Options
• 401(k) Plan
• Weekly Payroll Deposit
• Free Online CEUs
• Generous Housing Allowance
• Travel and Licensure Reimbursements
• Non-taxed Per Diem and Subsidy
• Traveler Rewards and Discounts

Job ID: P-760545

Open Positions: 1