Registered Nurse I - Case Manager

Our client is seeking a dedicated RN Case Manager to concurrently monitor and review member utilization for medical appropriateness. In this role, you will recommend alternative levels of care, proactively identify potential barriers or service delays, and facilitate comprehensive discharge planning activities to optimize patient outcomes. Responsibilities Perform initial inpatient admission medical necessity reviews and ongoing concurrent utilization screenings for in-network hospitalized patients using industry-standard criteria. Communicate frequently with hospitalists and specialty providers to clarify levels of care, solidify treatment plans, facilitate timely consultations, and resolve obstacles to a safe discharge. Anticipate and identify avoidable delays in physician decision-making or hospital processes. Initiate immediate corrective actions, escalations to the Medical Director when necessary, and document process issues to mitigate financial liability. Accomplish discharge screenings on all admissions, anticipate patient needs, and coordinate timely, safe discharges or SNF transfers. Ensure all required DME and Home Health needs are fully met. Maintain and update the Daily Hospital Log with real-time changes in patient status, level of care, procedures, and dispositions. Issue timely regulatory denial notifications when required. Maintain the highest level of professional decorum by using formal, respectful language, avoiding medical jargon, and ensuring patient and family questions are fully addressed. Requirements Current California RN License, or Board Eligible with a clear plan for obtaining licensure within a specified timeframe. At least 2 years of recent acute care hospital nursing experience, including telemetry, chart review, and analysis. Extensive understanding of diagnostic/invasive procedures with the ability to anticipate care plan changes; familiarity with Level of Care, Intensity of Service, Severity of Illness, and SNF/Home Health criteria. Proven ability to communicate professionally and interface assertively with physicians and multidisciplinary teams. Valid California driver’s license with proof of insurance required. BLS required within 60 days of hire only for roles involving direct patient care Physical Demands & Work Environment Active hospital role requiring a mix of walking (45%), standing (25%), and sitting (30%). Occasional lifting up to 40 lbs. Highly technical environment requiring the ability to utilize computers, keyboards, and monitors for more than 7 hours per day. #J-18808-Ljbffr