Registered Nurse - Case Manager/ Utilization Manager
Job Description
Immediate need for a talented Registered Nurse – Case Manager/ Utilization Manager. This is a 03+ Months Contract opportunity with long-term potential and is located in Santa Clara, CA (Onsite). Please review the job description below and contact me ASAP if you are interested.
Job ID:25-96149
Pay Range: $60 - $65/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Perform daily pre-admission, admission, and concurrent utilization reviews
- Determine appropriate levels of care using clinical guidelines and policies
- Coordinate inpatient discharge planning and transitions of care
- Participate in multidisciplinary rounds with physicians and care teams
- Communicate discharge plans with patients, families, and external providers
- Arrange transfers, post-acute services, and obtain authorizations as needed
- Ensure continuity of care through accurate documentation and follow-up
- Maintain compliance with federal, state, and institutional regulations
- Educate care teams on utilization and care coordination processes
Key Requirements and Technology Experience:
- Skills-Inpatient Case Management & Discharge Planning
- Utilization Management / Utilization Review (UM/UR)
- Acute hospital experience (inpatient setting)
- Knowledge of CMS, DMHC, NCQA, TJC, HIPAA, EMTALA
- Strong interdisciplinary communication and care coordination
- Ability to independently manage inpatient caseloads
- Healthcare benefit interpretation and authorization coordination
- Graduate of an accredited school of nursing
- Diploma or Associate Degree in Nursing (ADN) required
- Active California RN License (Required)
- BLS Certification (Required)
- Minimum 2 years of experience in:
- Utilization Management
- Case Management
- Discharge Planning
- Recent acute inpatient hospital experience
- Ability to work rotating schedules and every other weekend
- Comfortable working in a Labor/Management Partnership environment
- Bachelor’s degree in Nursing or healthcare-related field
- Master’s degree in Case Management
Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
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