Registered Nurse (RN) - Case Management

Details

Client Name
Providence Saint Mary Medical Center - Apple Valley

Job Type
Travel

Offering
Nursing

Profession
Registered Nurse (RN)

Specialty
Case Management

Job ID
37393837

Job Title
Registered Nurse (RN) - Case Management

Weekly Pay
$1656.0


Shift Details

Shift
Days - 5 x 8

Scheduled Hours
40


Job Order Details

Start Date
07/27/2026

End Date
10/26/2026

Duration
13 Week(s)


Job Description
Title
Utilization Review RN - Care Management

Schedule
Day shifts with a minimum of 4 weekend day shifts required within a 6-week period. Must commit to working 3 of the 5 major holidays.

Requirements
- Minimum 3 years of acute care medical Utilization Management experience performing utilization review in a hospital setting.
- Recent experience with Epic (within the last 6-12 months).
- Knowledge of InterQual criteria and medical necessity determination.
- Familiarity with Medicare regulations (CC44s, ABNs, HINNs, MCSNs, etc.).
- Competency in prior authorization, pre-certification, retrospective review, and handling appeals and denials.
- Understanding of coding (ICD-10, CPT, DRG).
- Knowledge of CMS, The Joint Commission/core measures, HEDIS/NCQA, and HIPAA regulations.

Roles & Responsibilities
- Conduct utilization reviews to determine the medical necessity of ongoing patient care.
- Utilize InterQual criteria to assess patient status and appropriateness of admissions and continued stays.
- Collaborate with healthcare teams to ensure optimal patient care and resource management.
- Handle prior authorization processes and facilitate necessary appeals and denials.
- Maintain compliant documentation in the electronic medical records system.
- Stay updated on medical policies and regulations to ensure adherence within the care management process.

Compliance / Notes
- Orientation consists of 40 hours.
- Must work within Pacific Standard Time and adhere to CA labor laws for breaks and lunches.
- Zero overtime or working off the clock unless pre-approved by leadership.
- Completion of training modules required before starting and annually thereafter.
- Required business attire for scrubs/dress code.


Client Details

Address
18300 US Highway 18

City
Apple Valley

State
CA

Zip Code
92307


Job Board Disclaimer

TLC Nursing Associates, Inc. is an equal-opportunity employer and fully complies with all applicable federal, state, and local laws. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, disability, age, genetic information, veteran status, or any other status protected under the law.
Accuracy of Information: All job listings are subject to change, and while we strive to ensure that all job information, including job descriptions, pay packages, and shift details, is accurate and up-to-date, we cannot guarantee the availability or specifics of any position at the time of application. Pay packages and shift availability may vary based on facility needs and may be subject to changes before or after hire.