Utilization Management Case Management Registered Nurse

Preferred Home Health Care & Nursing Services; Los Angeles (CA); On-site; USD 95,000 - 130,000; Full time

Job summary

Preferred Home Health Care & Nursing Services is seeking a Case Management Utilization RN to optimize patient care in a technology-enabled environment. The role focuses on utilization reviews, coordination of care plans, and safe care transitions.

The ideal candidate will have RN licensure with case management experience, knowledge of utilization management and discharge planning, and strong communication across clinical and administrative stakeholders.

Qualifications

• RN with strong clinical decision-making and case management experience.
• Knowledge of utilization management, managed care guidelines, and discharge planning.
• Ability to communicate effectively across clinical and administrative stakeholders.
• Comfort working with modern documentation and tracking systems to support continuous improvement.

Responsibilities

• Conduct utilization reviews using evidence-based criteria and managed care guidelines.
• Coordinate and support patient care plans with an interdisciplinary team.
• Facilitate safe, timely discharges and appropriate care transitions.
• Collaborate with physicians, nurses, social workers, and payers to align clinical and coverage needs.
• Use digital tools to document case findings, track relevant metrics, and support quality and operational improvements.

Skills

Registered Nurse

Case management

Utilization management

Discharge planning

Communication skills

Documentation systems

Tools

Electronic Health Records (EHR)

Job description

Case Management Utilization RN

Responsible for optimizing patient care and healthcare resource utilization in a technology-enabled environment.

Key Duties

• Conduct utilization reviews using evidence-based criteria and managed care guidelines.
• Coordinate and support patient care plans with an interdisciplinary team.
• Facilitate safe, timely discharges and appropriate care transitions.
• Collaborate with physicians, nurses, social workers, and payers to align clinical and coverage needs.
• Use digital tools to document case findings, track relevant metrics, and support quality and operational improvements.

Qualifications & Skills

• Registered Nurse with strong clinical decision-making and case management experience.
• Knowledge of utilization management, managed care guidelines, and discharge planning.
• Ability to communicate effectively across clinical and administrative stakeholders.
• Comfort working with modern documentation and tracking systems to support continuous improvement.