RN - Case Manager

Case Manager

This position reports to the Director of Case Management. Accountability for the practice of nursing lies with the Senior Vice President of Patient Care Services. Performs chart reviews and quality assessments on all patients using Severity of Illness and Intensity of Service criteria as directed by Administration and the Medical Staff. Emphasis on the identification and implementation of Case Management interventions that have less predictable outcomes. Monitors activity of observation cases to ensure timely patient discharge. If not discharged appropriately, ensures the physician writes an order for inpatient services. Initiates Medi-Cal TARs at the time of admission or as soon as possible thereafter. Documents daily using Severity of Illness and Intensity of Service criteria. Evaluates the Case Management Plan in changing patient care situations for patients within the assigned work shift. Educates physicians and appropriate personnel regarding criteria for Utilization Management. Provides documentation for denial letters and delivers them to patients as directed by the Utilization Management physician advisor. Researches and prepares appeals for denial claims. Uses innovative problem-solving skills in dealing with complex patient and significant other situations. Identifies inappropriate bed utilization and quality of care problems and refers them to the Utilization Management physician advisor.

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.

We offer competitive benefits, including:

• Medical, dental & vision insurance
• 401(k) with employer match
• Free and unlimited continuing education units (CEUs)
• Disability insurance
• 24/7 dedicated Care Line and clinical liaison support
• Personalized career consultant and "single point of contact" service
• Industry‑leading pay rates, loyalty rewards & referral bonuses
• Free tax return assistance for travelers

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