Local Contract Nurse Senior RN - Care Manager
Irvine, CA
Hanker Systems Inc
5x8 hrs, Days
Referral Bonus

Job Title: Travel Registered Nurse (RN) - Case Manager / Utilization Review

Location: Irvine
Facility: City of Hope
Contract Duration: 13 Weeks
Start Date: June 16, 2026
Shift: Day Shift - 3x12 Hours (07:00 AM – 07:30 PM)
 

Position Overview

We are seeking an experienced Case Manager / Utilization Review RN for a complex inpatient oncology setting. This role focuses on care coordination, discharge planning, and ensuring appropriate utilization of healthcare services while maintaining compliance with regulatory standards.

Key Responsibilities

• Perform comprehensive case management and utilization review for inpatient oncology patients
• Conduct admission, concurrent, continued stay, and retrospective reviews
• Ensure medical necessity using evidence-based criteria such as:
  • InterQual
  • Milliman Guidelines
• Coordinate patient care across multidisciplinary teams
• Lead discharge planning and transitions of care
• Manage appeals and denials processes
• Maintain compliance with regulatory bodies including:
  • Centers for Medicare and Medicaid Services (CMS)
  • The Joint Commission
• Utilize coding and classification systems such as:
  • DRG (Diagnosis Related Groups)
  • ICD-10
  • CPT coding
• Document all care activities in Epic
• Communicate effectively using SBAR methodology

Requirements

• Experience: Minimum 5 years in Case Management / Utilization Review (acute care required)
• Education: BSN required
• Licensure: Active RN State License (California required)
• Certifications:
  • BLS (Basic Life Support)

Required Skills & Expertise

• Acute Hospital and Post-Acute settings (LTAC, Rehab, Skilled Nursing)
• Care Coordination & Discharge Planning
• Utilization Review processes:
  • Admission criteria
  • Concurrent and continued stay reviews
  • Appeals & denials
• Strong knowledge of:
  • CMS regulations
  • HEDIS measures
  • HIPAA compliance
  • National Committee for Quality Assurance (NCQA) standards
  • OSHA and Department of Health regulations

Work Schedule & Additional Details

• Weekend requirement: Every other weekend
• No call required
• Patient population: Adults & Geriatrics
• Orientation: 8 hours