Job Description

Immediate need for a talented RN – Case Manager/ Utilization Review. 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: 26-03817

Pay Range: $75 - $90/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

• Schedule: 8:00 AM – 4:30 PM
• 5 days/week including
• 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;

• Key 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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