RN - Case Manager

Case Manager and Utilization Review RNJob Title: Case Manager and Utilization Review RNProfession: Registered NurseSpecialty: Case ManagerDuration: 13 weeksShift: DayHours per Shift: 8 hoursExperience: 5 years requiredLicense: State License requiredCertifications: BLS, BSNMust-Have: Acute Client experience, Long Term Acute Care/Rehab/Skilled Nursing experience, Epic documentation experience, InterQual documentation experienceDescription: Case Manager and Utilization Review RN for Cancer Specialty Client. Five years of experience is required. Utilize Epic and InterQual documentation. SBAR communication is essential. Weekends are required. BLS, BSN, and State License are mandatory certifications. Skills and experience required include: Acute Client experience. Understanding of Long Term Acute Care/Rehab/Skilled Nursing. Knowledge of Admission Criteria. Care Coordination expertise. Discharge Planning abilities. Application of InterQual Criteria. Utilization of Milliman Guidelines. Understanding of UR Admission Criteria. Experience with UR Appeals and Denials. UR Concurrent Review experience. UR Continued Stay Reviews knowledge. UR Medical Necessity expertise. UR Retrospective Review experience. Understanding of CMS guidelines. Familiarity with CPT coding and billing. Knowledge of the Department of Health regulations. Understanding of DRG (Diagnosis Related Groups). Familiarity with HEDIS measures. Knowledge of HIPAA guidelines. Experience with ICD 10 coding. Awareness of NCQA standards. Understanding of OSHA regulations. Knowledge of The Joint Commission Core Measure/National Safety Goals. Understanding of Workers Compensation regulations.We offer competitive benefits, including:Medical, dental & vision insuranceFree and unlimited continuing education units (CEUs)24/7 dedicated Care Line and clinical liaison supportPersonalized career consultant and "single point of contact" serviceIndustry?leading pay rates, loyalty rewards & referral bonusesFree tax return assistance for travelers401(k) Retirement PlanHealth Savings Account (HSA)Disability Insurance (Short-Term and Long-Term)Life and AD&D InsurancePaid Sick Leave (where required by applicable state or local law)Supplemental Insurance PlansIdentity Theft ProtectionPet InsuranceEmployee Wellness ProgramsEmployee Assistance Program (EAP)Career Growth and Professional Development OpportunitiesDisclaimer: Benefits eligibility, accrual rates, and usage limits may vary based on employment status, length of service, and work location. Paid Sick Leave is provided in strict accordance with applicable state and municipal mandates. Cynet Health reserves the right to modify, amend, or terminate any benefit plans at any time in accordance with applicable laws.About Cynet Health: Cynet Health is a Joint Commission-accredited, Minority-Owned healthcare staffing agency headquartered in Sterling, Virginia, proudly serving healthcare facilities across the United States since its founding in 2010. As one of the nation's largest and fastest?growing healthcare staffing firms in the nation, we staff thousands of nursing, allied health, locum tenens, pharmacy, therapy, direct?hire, and non?clinical professionals across hospitals, clinics, long?term care facilities, labs and more. We're one of the most decorated staffing agencies in America-ranked a Top Travel Nursing Company by BluePipes, recognized among the fastest?growing and most diverse staffing firms by Inc. 5000, Staffing Industry, WBJ and USPAACC-and remain deeply committed to excellence, inclusion, and community impact.Job Board Disclaimer By applying for jobs on this website, you consent to receive daily messages from CYNET about assignments that match your profile. Email or text "HELP" for more info, or "STOP" to unsubscribe. Your mobile info will not be shared with third parties for marketing. Standard messaging and data rates may apply.