Job Title: Registered Nurse Case Manager
Location: San Pedro, CA
Schedule: 08:00 16:30 (5x8; Self-scheduling; every other weekend)
Duration: 13 weeks
Pay Rate: $68/hr (W2) | $72/hr (1099)
Position Summary
We are seeking an experienced Registered Nurse Case Manager to join our Case Management team. This role focuses on care coordination, utilization review, and discharge planning in an acute care setting. The RN Case Manager will manage a patient caseload, ensuring timely and appropriate care transitions while meeting regulatory and payer requirements.
Key Responsibilities
Perform Care Coordination, Utilization Review, and Discharge Planning for acute care patients (Medical-Surgical, Telemetry, ICU, and occasional ER).
Conduct admission criteria reviews using InterQual guidelines.
Facilitate concurrent and continued stay reviews to determine medical necessity per evidence-based guidelines.
Coordinate services with interdisciplinary teams, including physicians, social services, and interpretation services.
Arrange necessary resources and equipment (DME), complete prior authorizations, and initiate post-acute referrals.
Document all case management activities in Epic EMR system.
Ensure compliance with CMS, HIPAA, The Joint Commission, and California Department of Health regulations.
Participate in weekend rotation; patient load may exceed 15 patients on weekends based on census.
Required Qualifications (HARDSTOPS)
California RN license (active and unencumbered).
Minimum 2 years acute medical Case Manager experience in California, performing all of the following:
Care Coordination
Utilization Review
Discharge Planning
Proficiency with InterQual and Epic .
Experience with Medical-Surgical, Telemetry, ICU, and some ER case management.
Seasoned traveler experience (first-time travelers may be screened by manager).
Preferred Skills & Experience
DRG coding knowledge
Prior authorization and retrospective review experience
Worker's compensation case management
Knowledge of NCQA and HEDIS measures
Work Environment & Caseload
Setting: Acute hospital, Case Management/Utilization Review
Patient Age Groups: Adults, Geriatrics
Daily Census: 50 55
Typical Caseload: 1:15 weekdays; may be higher on weekends
Support Services: Social Services, Interpretation Services
Foods you love. Brands you trust. And a career that empowers you to grow.At Nestl USA, we're all working towards the same goal - to delight and deliver for our consumers. With a rich portfolio of beloved brands, including DiGiorno, Toll House, and Coffee mate, in 97% ...
**Physical Therapy Assistant / PTA- Outpatient****Great Work/life Balance and Flexibility of hours****Full-time, Part-time & Consistent PRN Opportunities... ...or in an on-site outpatient clinic so there's no need to travel to homes outside the building. At Aegis Therapies, we take...
...The Role We are seeking a Marketing Project Manager to oversee the execution of marketing initiatives, drive engagement, and optimize results through data-driven strategies. This role requires a proactive problem solver with strong project management skills, the ability...
...Owner Operator / 26' Box Truck with lift gate Medford, OR Delivering critical medical supplies Responsibilities: Timely pickup and delivery of medical supplies. Handling time-sensitive materials. Utilizing our Delivery App for routing and updates....
We are seeking qualified individuals interested in introducing youth to outdoor leadership, natural science education, and outdoor recreation through overnight programs in the Colorado National Monument and the White River National Forest. Overnight Guides must be passionate...