Travel Nurse RN - Case Management
San Pedro, CA
LanceSoft
5x8 hrs, Days

*AUTO OFFER*

• Active California RN License (Required)
• Acute Care Experience REQUIRED – MUST HAVE:
  • Med-Surg (MS)
  • MS/Telemetry
  • ICU
  • Some Emergency Room (ER) exposure
• Current/Recent Case Management Experience in California (REQUIRED)
• Hands-on experience with:
  • Care Coordination
  • Utilization Review
  • Discharge Planning
  • InterQual Criteria
  • EPIC Charting System
• NO First-Time Travelers

Job Summary:

We are seeking an experienced RN Case Manager with a strong acute care background to support care coordination, utilization management, and discharge planning. This role requires a candidate who can independently manage complex cases while ensuring compliance with evidence-based guidelines and regulatory standards.

Key Responsibilities:

• Perform utilization review including admission criteria, concurrent review, and continued stay reviews
• Coordinate patient care and discharge planning across the continuum
• Determine medical necessity using InterQual guidelines
• Manage prior authorizations, benefits eligibility, and payer communication
• Conduct needs assessments and arrange post-acute services (DME, rehab, etc.)
• Collaborate with interdisciplinary teams for optimal patient outcomes
• Maintain accurate documentation in EPIC
• Ensure compliance with CMS, HIPAA, and Joint Commission standards

Requirements:

• Active California RN License (Required)
• Minimum 2+ years acute care experience (MS, Tele, ICU, ER REQUIRED)
• Recent Case Management experience in California (REQUIRED)
• Strong Utilization Review & Discharge Planning experience
• Proficiency with InterQual & EPIC (REQUIRED)
• Excellent communication and critical thinking skills

Preferred Qualifications:

• Experience with prior authorizations & retrospective reviews
• Knowledge of DRG, HEDIS, ICD-10, and CPT coding
• Worker’s Compensation case management experience