Acute Care, Basic Life Support (BLS), Case Management, Discharge Plans, Healthcare, Healthcare Reimbursement, Medical Office, Patient Admissions, Patient Care, Problem Solving Skills, Registered Nurse (RN), Regulatory Compliance, Utilization Management
Job Title: RN – Case Management (Utilization Review)
Location: Bakersfield, CA – 93306
Duration: 13 Weeks with possibility of extension
Schedule: Mon-Friday 8-4:30
Job Summary
The RN Case Manager performs advanced utilization review and discharge planning activities to ensure appropriate patient care, compliance with payer requirements, and optimal reimbursement.
Responsibilities- Evaluate inpatient admissions for medical necessity
- Conduct ongoing case reviews and recommend care adjustments
- Develop and implement discharge plans
- Coordinate with physicians and healthcare teams
- Resolve payer and authorization issues
- Educate providers on documentation requirements
- Review elective procedures for authorization compliance
Requirements- Minimum 2 years RN experience in acute care(Page 2)
- At least 1 year Med/Surg experience(Page 2)
- Plus either:
- 1 year Utilization Review / Discharge Planning experience
- OR 2 years Case Management experience (clinic/physician office)
- Active CA RN License
- BLS certification
- Strong knowledge of payer guidelines and documentation
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Integrated Resources, Inc