RN - Case Manager

Case Manager and Utilization Review RN

Job Title: Case Manager and Utilization Review RN

Profession: Registered Nurse

Specialty: Case Management

Duration: 13 weeks

Shift: Day 5x8-Hour Hours per Shift: 8

Experience: 5 years required in acute hospital and long-term care settings

License: State License required

Certifications: BLS, BSN required

Must-Have:

• Epic documentation experience
• InterQual documentation experience
• Experience with admission criteria, care coordination, and discharge planning
• Knowledge of UR (Utilization Review) processes including appeals, denials, concurrent reviews, and retrospective reviews
• Familiarity with CMS guidelines, CPT coding, DRG, HEDIS measures, HIPAA guidelines, ICD 10 coding, and NCQA standards

Description: We are seeking a Case Manager and Utilization Review RN specializing in cancer care. Candidates must have a minimum of 5 years of experience in acute hospital settings or long-term acute care, rehabilitation, or skilled nursing facilities. Experience with Epic and InterQual documentation is essential. Candidates will be responsible for managing the utilization review process, ensuring compliance with medical necessity and admission criteria. Key responsibilities include care coordination, discharge planning, and adherence to regulatory guidelines. Weekend shifts are required for this position. Successful candidates will demonstrate effective communication using SBAR techniques and have knowledge of revenue cycle processes. Candidates must possess the necessary certifications and a valid state nursing license upon application.

Client Details: City Irvine State CA

Benefits:

• Medical, dental & vision insurance
• Free and unlimited continuing education units (CEUs)
• 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
• 401(k) Retirement Plan
• Health Savings Account (HSA)
• Disability Insurance (Short-Term and Long-Term)
• Life and AD&D Insurance
• Paid Sick Leave (where required by applicable state or local law)
• Supplemental Insurance Plans
• Identity Theft Protection
• Pet Insurance
• Employee Wellness Programs
• Employee Assistance Program (EAP)
• Career Growth and Professional Development Opportunities

Disclaimer: 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.

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