Case Management RN
Eureka, CA
Bestica
5x8 hrs, Days
Referral Bonus

Required Qualifications

• Minimum 2 years of acute-care hospital Case Management experience.
• Recent acute-care hospital Case Management experience within the last year is mandatory.
• Previous travel experience required; first-time travelers may be considered with clinical approval.
• Strong experience in Care Coordination and Discharge Planning.
• Epic experience is mandatory.
• Experience working with HMOs, IPAs, and similar healthcare organizations.
• Experience with Advance Directives, POLST, and Protective Services processes.

Key Responsibilities & Clinical Skills

• Acute hospital Case Management and Utilization Review.
• Care Coordination and Discharge Planning.
• Admission criteria and medical necessity reviews.
• Appeals and Denials management.
• Benefits eligibility and patient needs assessments.
• DME coordination and prior authorizations.
• Coordination with interdisciplinary teams, including Social Services.
• Knowledge of CMS guidelines, HIPAA, DRGs, and Joint Commission standards.
• Experience supporting patients across ICU, Emergency Department, Medical-Surgical, Pediatrics, and Step-Down/PCU units.