RN Case Manager
Irvine, CA
Concentric Healthcare Staffing
5x8 hrs, Days

Job Title

Registered Nurse – Case Management (Hospital)

Location

Irvine, CA

Schedule / Job Type

Contract | Days (5x8 Hours, 8:00–16:30) | Onsite | Rotating Weekends Required

Key Responsibilities

• Perform complex inpatient case management and utilization review for a cancer specialty hospital setting
• Conduct UR functions including admission criteria review, concurrent review, continued stay reviews, retrospective review, and appeals and denials
• Apply InterQual and Milliman guidelines to support medical necessity determinations
• Coordinate care and facilitate discharge planning for acute and complex patient populations
• Communicate clinical information using SBAR methodology and document accurately in Epic
• Ensure compliance with CMS, HIPAA, OSHA, The Joint Commission, and other applicable regulatory standards

Required Qualifications

• Active California RN license (must be in hand at time of submission; no pending licenses accepted)
• Bachelor of Science in Nursing (BSN) required
• Current BLS certification (must be in hand; no pending certifications accepted)
• Minimum of 5 years of experience in case management or utilization review specialty
• Experience in acute hospital and post-acute settings including Long Term Acute Care, Rehabilitation, and Skilled Nursing
• Proficiency with Epic EMR and InterQual criteria documentation

Preferred Experience / Skills

• Working knowledge of ICD-10 and CPT coding, DRG, and HEDIS measures
• Familiarity with NCQA standards and Workers' Compensation processes
• Experience with Department of Health regulations and National Safety Goals

Why Join Us

• Opportunity to work in a specialized oncology hospital environment with a focus on complex, high-acuity case management
• First-time travelers welcome; travel pairs accepted