RN Case Manager – Utilization Review
Bakersfield, CA
Host Healthcare
5x8 hrs, Days
Referral Bonus

Job Opportunity: RN Case Management (Utilization Review)

Location: Bakersfield, California
Employment Type: Clinical Nursing Travel
Shift: Day
Hours: 8 hours/day, 40 hours/week
Contract Length: 13 weeks

Job Summary

The Utilization Review Nurse II is a fully experienced role focused on utilization review and discharge planning activities.

Key Responsibilities

• Obtain and evaluate medical records for inpatient admissions to ensure required documentation is present.
• Acquire necessary records for payor agencies and initiate Physician Advisories for unwarranted admissions.
• Conduct ongoing reviews and discuss care changes with attending physicians and other healthcare providers.
• Formulate and document discharge plans.
• Provide consultation and coordination with multiple hospital services to ensure efficient resource use.
• Identify pay source issues and intervene for appropriate referrals.
• Coordinate with admitting office to prevent inappropriate admissions.
• Work with clinic areas to schedule specialized tests, assess pay sources, and authorize payments under relevant programs.
• Review and approve surgery schedules to ensure elective procedures are authorized.
• Coordinate with correctional facilities regarding elective procedures, durable medical goods, and other services.
• Respond to provider questions about reimbursement, prior authorization, and documentation requirements.
• Stay informed about patient disease processes and treatment modalities.
• Educate providers on payor documentation requirements to maximize hospital reimbursement.
• May assist in training Utilization Review Nurse I staff.

Required Qualifications

• Current RN license valid in California.
• Experience in utilization review and discharge planning (minimum years of experience not explicitly stated; assume fully experienced level).

Additional Information

• This is a travel nursing position requiring clinical nursing expertise in case management and utilization review.
• The role involves collaboration with multiple departments and external agencies to optimize patient care and hospital resource utilization.