Initial Clinical Reviewer- RN Case Manager

Location: Lake Forest, CA (100% On-Site) Salary: $80,000 - $90,000 / year + Comprehensive Benefits Job Type: Full-Time Why Join Intelligent Medical Solutions (IMS)? At IMS, we blend clinical expertise with smart technology to drive exceptional medical management outcomes. As an RN Utilization Review Case Manager , you won't just review cases—you'll serve as a critical decision-maker ensuring injured workers receive proper, evidence-based care while keeping medical systems compliant and efficient. We provide top-tier benefits, employer-matched 401(k), professional development opportunities, and fully equipped workstations (monitors, computers, and tech set up for success). Key Responsibilities Clinical Evaluations: Perform prospective, concurrent, and retrospective utilization reviews using state-specific Workers Compensation guidelines and evidence-based clinical criteria. Care Authorizations & Escalations: Authorize medically necessary treatment requests or package complex cases with clear clinical rationales for physician review. Compliance & Quality: Maintain strict compliance with state turnaround times, state-specific UR regulations, and internal quality standards. Professional Communication: Deliver clear, high-quality review reports and field clinical calls with professional authority and clear rationale. Team Collaboration & Leadership: Participate in department committees and mentor junior clinical reviewers to help elevate team standards. What You Need to Succeed Required: Education & License: Graduate of an accredited School of Nursing with an active, unrestricted RN license. Clinical Background: 3+ years of clinical nursing experience. Specialized Experience: 3+ years in Workers Compensation . 2+ years in Utilization Review (familiarity with CPT, HCPCS, Carve-outs, and Bill Review). 2+ years in IT-adjacent clinical roles (e.g., Data Analyst, Clinical Documentation Improvement / CDI). Technical Skills: High proficiency with MS Office (Excel, Word), case management systems, and clinical data tracking. Core Strengths: Ability to thrive in a high-volume, deadline-driven environment with minimal supervision and strong clinical judgment. Preferred: Bachelor of Science in Nursing (BSN) or related degree. Healthcare: Health, Dental, and Vision Insurance Financial Security: 401(k) with Employer Matching, Health Savings Account (HSA), and Flexible Spending Account (FSA) Work-Life Balance: Generous Paid Time Off (PTO) and Flexible Scheduling options Growth & Support: Education Assistance Opportunities & full company-provided hardware setup #J-18808-Ljbffr Intelligent Medical Solutions - IMS