Job Description

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

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