Rn Utilization Review Nurse Case Manager

Job Summary:

The Utilization Review Nurse / Case Manager is responsible for evaluating patient care to ensure appropriate use of healthcare resources and effective discharge planning. This role involves reviewing medical records, coordinating with healthcare providers, and managing cases to optimize patient outcomes and compliance with regulatory standards. The nurse will collaborate with interdisciplinary teams to facilitate patient care transitions and maintain documentation accuracy. An active California RN license, BLS, and ACLS certifications are required, along with at least 4 years of relevant experience.

• Conduct utilization reviews to assess the necessity and appropriateness of patient care services.
• Perform case management and discharge planning to support safe and timely patient transitions.
• Collaborate with healthcare providers, patients, and families to coordinate care plans.
• Maintain accurate and timely documentation of reviews, case notes, and communications.
• Ensure compliance with hospital policies, payer requirements, and regulatory standards.
• Provide recommendations for resource utilization and patient care improvements.
• Participate in interdisciplinary team meetings and quality improvement initiatives.

• Active Registered Nurse license in California.
• Current BLS (Basic Life Support) certification.
• Current ACLS (Advanced Cardiovascular Life Support) certification.
• Proof of negative TB screening within the past 12 months.
• Minimum of 4 years of experience in utilization review, case management, or related nursing roles.
• Strong clinical assessment and case management skills.
• Excellent communication and collaboration abilities.

• Experience with discharge planning in acute care or community hospital settings.
• Familiarity with utilization management software and electronic medical records.
• Knowledge of payer policies and regulatory compliance in healthcare.
• Experience working in a community hospital environment.

• Position is temp-to-perm with preference against long-term contracts.
• Must be able to work within a 30-mile radius of the hospital in the Arcata, Eureka, McKinleyville, Blue Lake, Samoa, Fortuna areas.
• Must provide proof of negative TB test within the last 12 months.

• Five 8-hour shifts per week, totaling 40 hours guaranteed.
• Day shift schedule.