Travel RN: Utilization Review & Case Management

TravelNurseSource; Orange (CA); On-site; USD 105,000 - 132,000; Full time

Job summary

TravelNurseSource is seeking a Utilization Review RN in Orange, California, to support Prime Staffing on a 13-week contract. The position requires 2+ years in utilization review or related nursing roles, with active RN licensure and BLS/AHA certification.

The role focuses on reviewing medical records to determine admission necessity and coordinating with providers, insurers, and case managers to ensure compliance with guidelines and optimize patient outcomes while controlling costs.

Qualifications

• 2+ years of experience in utilization review, case management, or acute care nursing
• BLS – AHA certification preferred
• Certified Case Manager (CCM) preferred
• Strong understanding of insurance guidelines and medical necessity criteria (InterQual or MCG)
• Discharge planning knowledge

Responsibilities

• Review medical records to determine hospital admission appropriateness and medical necessity
• Collaborate with providers, insurance companies, and case managers to ensure coverage compliance and cost effectiveness
• Support discharge planning and care coordination

Skills

Utilization review

Case management

Nursing

Job description

TravelNurseSource is seeking a Utilization Review RN in Orange, California, to support Prime Staffing on a 13-week contract. The position requires 2+ years in utilization review or related nursing roles, with active RN licensure and BLS/AHA certification.

The role focuses on reviewing medical records to determine admission necessity and coordinating with providers, insurers, and case managers to ensure compliance with guidelines and optimize patient outcomes while controlling costs.