Utilization Review/Case Management RN

Utilization Review/Case Management RN
Immediate need for a talented Utilization Review/Case Management RN. This is a 03+ Months Contract opportunity with long-term potential and is located in Santa Clara, CA (Onsite).

Job ID:25-96149 Pay Range: $75 - $85/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:
  • Utilization Management: Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.
  • Monitors the progression of the discharge plan and facilitates discussions with the multidisciplinary teams.
  • Educates other healthcare team members on utilization and care coordination.
  • Collaborates with and provides information to patients, families, physicians, and staff regarding the discharge plans and transitions.
  • Understands and consistently applies the interpretation, and utilization of member health care benefits.
  • Conducts UM, care coordination and discharge planning activities according to all applicable regulatory requirements.
  • Discharge Planning: Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient.
  • Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other health care providers and agencies.
  • Regulatory: Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements.
  • Shift Timings: 8:00 AM – 4:30 PM – 5 days/week including ever
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