Utilization Review/Case Management RN

Utilization Review/Case Management RN

Immediate need for a talented Utilization Review/Case Management RN. This is a 03+ Months Contract opportunity with long-term potential and is located in Santa Clara, CA (Onsite).

Job ID:25-96149 Pay Range: $75 - $85/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Utilization Management: Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.
• Monitors the progression of the discharge plan and facilitates discussions with the multidisciplinary teams.
• Educates other healthcare team members on utilization and care coordination.
• Collaborates with and provides information to patients, families, physicians, and staff regarding the discharge plans and transitions.
• Understands and consistently applies the interpretation, and utilization of member health care benefits.
• Conducts UM, care coordination and discharge planning activities according to all applicable regulatory requirements.
• Discharge Planning: Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient.
• Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other health care providers and agencies.
• Regulatory: Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements.
• Shift Timings: 8:00 AM 4:30 PM 5 days/week including every other weekend (both Saturday & Sunday).
• Days vary but we are looking for 2 travelers to fill the schedules below:
• Traveler 1 Mon, Tue, Wed, Fri, Sat Sun, Mon, Wed, Thu, Fri
• Traveler 2 Mon, Tue, Thu, Fri, Sat Sun, Tue, Wed, Thu, Fri

Key Requirements and Technology Experience:

• Recent hospital/acute care setting experience
• Strong discharge planning background
• Availability aligned with the outlined shift schedules
• Minimum two (2) years of experience in utilization review, case management, and discharge planning.
• Graduate of accredited school of nursing.
• Diploma/Associate Degree in Nursing.
• Registered Nurse License (California) Required upon hire.
• Basic Life Support (BLS) Required upon hire.
• Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPAA, ERISA, EMTALA & all other applicable federal/state/local laws & regulations.
• Demonstrated strong communication and customer service skills, problem-solving, critical thinking, & clinical judgment abilities.
• Fundamental word processing & computer navigation skills & the ability to interpret & use analytic data in day to day operations.
• Knowledge of health care benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).
• Must be able to work in a Labor/Management Partnership environment.
• Acute inpatient hospital-level experience.
• Bachelor's degree in nursing or a health care related field preferred.
• Master's degree in case management preferred.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.