Utilization Review Nurse / Case Manager
Arcata, CA
AMN Healthcare Nursing
5x8 hrs

Job Description & Requirements
Utilization Review Nurse/Discharge Planner
StartDate: ASAP Pay Rate: $1800.00 - $2500.00

POSITION SUMMARY – CA - Utilization Review Nurse / Case Manager

POSITION DUTIES – Conduct concurrent, retrospective, and prospective reviews to determine medical necessity and appropriateness of healthcare services.

Apply InterQual, MCG, and payer-specific guidelines to support utilization management decisions.

Coordinate patient care across the continuum from admission through discharge and post-acute services.

Collaborate with physicians, nurses, social workers, and interdisciplinary teams to develop and implement effective care plans.

Obtain and manage prior authorizations for medical procedures, treatments, and specialty services.

Monitor patient progress, length of stay, and resource utilization to ensure quality and cost-effective care.

Identify barriers to care and facilitate solutions that promote timely treatment and safe discharge planning.

Educate patients and families regarding treatment options, community resources, and healthcare benefits.

Communicate with insurance providers regarding admissions, continued stays, appeals, and authorization determinations.

Maintain accurate and compliant documentation in electronic medical records and case management systems.

Review denials and prepare clinical documentation to support appeal submissions.

Ensure compliance with Medicare, Medicaid, commercial payer requirements, and regulatory standards.

Participate in quality improvement initiatives designed to improve patient outcomes and reduce unnecessary healthcare utilization.

Advocate for patients while balancing clinical needs, payer requirements, and organizational objectives.

Track key performance metrics, including length of stay, readmission rates, and utilization trends.

MINIMUM REQUIRED QUALIFICATIONS – Active Registered Nurse (RN) license in the state of California, in good standing.

Associate Degree in Nursing (ADN) required.

Minimum 4 years of recent clinical nursing experience in an acute care hospital, case management, utilization review, or discharge planning setting.

PREFERRED QUALIFICATIONS – Bachelor of Science in Nursing (BSN) preferred

LENGTH OF ASSIGNMENT – 13 weeks

SHIFT / HOURS PER WEEK – 8:00am - 4:30pm

SYSTEMS – CPSI/Evident

START DATE –ASAP

Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don't stop there. There are many additional benefits to enjoy, including:

• Medical, dental and vision benefits
• Earned time off and paid holidays
• Paid continuing education time
• 401(K) retirement planning
• Short-term disability, life insurance, paid jury duty
• Access to the largest network of facilities and providers in the country
• Industry experienced workforce management team
• Licensure and certification reimbursement

About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.