Local Contract Nurse RN - Case Management
Irvine, CA
Apidel Technologies
3x12 hrs, Days
Referral Bonus

Position Overview
The Registered Nurse – Case Manager is responsible for coordinating patient care across the continuum, ensuring appropriate utilization of healthcare services, and supporting optimal patient outcomes. This role involves utilization review, discharge planning, and compliance with regulatory standards within acute and post-acute care settings.
Key Responsibilities
Perform case management and utilization review to ensure medical necessity and appropriate level of care
Coordinate patient admissions, concurrent reviews, and continued stay reviews
Develop and implement discharge planning and care coordination strategies
Evaluate cases using InterQual and Milliman guidelines
Conduct retrospective reviews, appeals, and denial management
Collaborate with physicians, nurses, and interdisciplinary teams for patient care planning
Ensure compliance with CMS guidelines and regulatory requirements
Maintain accurate documentation aligned with HIPAA and healthcare standards
Monitor patient progress and adjust care plans accordingly
Required Skills & Qualifications
Active California Registered Nurse (RN) license (required at submission)
BLS certification (preferred)
Strong experience in case management and utilization review
Proficiency in:
Admission criteria & medical necessity review
Discharge planning and care coordination
Appeals, denials, and retrospective reviews
Hands-on experience with:
InterQual and Milliman guidelines
Concurrent and continued stay reviews
Knowledge of healthcare regulations and standards:
CMS, HIPAA, NCQA, HEDIS, OSHA, Joint Commission
ICD-10, CPT coding, DRG classification