What are the responsibilities and job description for the RN- ED Case Management (Utilization Review) position at Careers Integrated Resources Inc?
- Job Title: RN ED Case Manager
- Location: Bakersfield, CA
- Contract Length: 13 Weeks (Extension likely)
- Shift: Night Shift 7p-7:30a/ 11p-7:30a Working 3 – 12hr shifts 1 week AND 3 - 12hr shift 1 - 8hr shift the next week
- Local Pay: $70–$80/hour (W2) – Negotiable
- Travel Weekly Gross: $2,800 – $3,300
Stipends: Available for candidates residing 50 miles from the facility
Key Responsibilities
- Review inpatient admissions and ongoing stays to determine medical necessity and appropriate level of care using InterQual guidelines
- Obtain, evaluate, and manage medical records to ensure required documentation is complete and payor-compliant
- Initiate Physician Advisories for unwarranted admissions or care deviations
- Conduct continued stay reviews and collaborate with attending physicians on care plan changes
- Develop, document, and coordinate comprehensive discharge plans
- Serve as a utilization and reimbursement subject-matter expert for providers and clinical teams
- Identify payor issues and coordinate referrals to appropriate financial or social services
- Coordinate with admitting, clinic, and surgical scheduling teams to prevent inappropriate admissions and unauthorized procedures
- Review and approve elective surgery schedules to confirm authorization and coverage
- Coordinate care and authorization needs involving correctional facilities, including elective procedures and DME
- Educate providers on documentation standards to maximize reimbursement and audit readiness
- Assist with training and mentoring Utilization Review Nurse I staff (Level II scope)
Required Qualifications
- Active Registered Nurse (RN) license in the State of California
- BLS (AHA Healthcare Provider) certification (or obtain within 60 days of hire)
- Utilization Review experience using InterQual guidelines
- Minimum 1 year of Utilization Review experience in an acute care setting
Experience Pathways:
- Level I:
2 years acute care RN experience, including at least 1 year in Medical/Surgical nursing - Level II (Required for this role):
1 year utilization review and/or discharge planning experience in an acute care hospital OR 2 years of case management experience in a clinic or physician office performing utilization review or discharge planning
Preferred Qualifications
-
1 year of Emergency Department Case Management experience
Salary : $70 - $80