Local Contract

Local Contract Nurse RN - Case Management
Irvine, CA
Hanker Systems Inc
3x12 hrs, Days
Referral Bonus

$58-65/hour

Posted 3 days ago

Overview

Start Date06/16/2026
Shift Breakdown3x12 hrs
ShiftDays
Duration13 weeks

Pay

Estimated pay

$58-65/hour

Benefits

License and certification reimbursement
Referral bonus

Description

Registered Nurse (RN) – Case Manager / Utilization Review

Location: Irvine, CA 92618
Unit: Case Management / Utilization Review
Shift: Day Shift – 3x12 (7:00 AM – 7:30 PM)

Key Responsibilities

Perform inpatient case management and utilization review for oncology patients
Conduct admission, concurrent, continued stay, and retrospective reviews
Apply InterQual and Milliman guidelines to determine medical necessity
Manage appeals and denials
Coordinate care across acute hospital, LTAC, rehab, and skilled nursing facilities
Lead discharge planning and care coordination
Communicate with physicians and interdisciplinary teams using SBAR
Ensure compliance with CMS, Joint Commission, NCQA, HIPAA, and regulatory standards
Complete detailed documentation using Epic and InterQual

Required Qualifications

Active RN license
BSN REQUIRED
BLS certification
Minimum 5 years Case Manager / Utilization Review experience
Strong experience with:
- Acute hospital and post‑acute settings
- InterQual & Milliman criteria
- Appeals, denials, and medical necessity reviews
- CMS, DRG, CPT, ICD‑10, HEDIS, and regulatory requirements
Epic documentation experience

This role focuses on medical necessity, utilization review, care coordination, and discharge planning across acute and post‑acute settings. Minimum 5 years of CM/UR experience required. Every‑other‑weekend coverage required.