Case Manager - Utilization Review

Job Title-RN Case Manager -

Utilization Review Contract Details Start Date:

07/27/2026

End Date:

10/23/2026

Duration:

13

Weeks Schedule:

5x8

Days Shift:

Day Shift Hours:

40

Hours/Week Location:

Bakersfield, California Job Description Seeking an experienced RN Case Manager - Utilization Review to perform utilization management, discharge planning, reimbursement review, and care coordination activities within an acute care hospital setting. The ideal candidate will possess strong clinical judgment, knowledge of payer requirements, and experience collaborating with physicians and multidisciplinary teams to ensure appropriate resource utilization and reimbursement compliance. Key Responsibilities Utilization Review Review inpatient admissions to determine medical necessity and appropriate level of care. Evaluate medical records for compliance with payer and regulatory requirements. Obtain supporting clinical documentation for insurance and reimbursement purposes. Initiate physician advisories regarding inappropriate or unwarranted admissions. Perform concurrent reviews and communicate findings to physicians and care teams. Case Management & Discharge Planning Develop and document comprehensive discharge plans. Coordinate post-acute services and patient transitions of care. Collaborate with social workers, physicians, nursing staff, and ancillary departments. Ensure timely discharge planning and efficient resource utilization. Address barriers to discharge and reimbursement. Reimbursement & Regulatory Compliance Maintain knowledge of Medicare, Medicaid, Managed Care, and commercial payer requirements. Educate providers regarding documentation requirements. Review authorizations and reimbursement criteria. Identify reimbursement issues and initiate corrective actions. Support compliance with governmental regulations affecting reimbursement. Coordination & Education Serve as a resource regarding utilization review processes. Communicate effectively with physicians, payers, and interdisciplinary teams. Assist in training and mentoring less experienced utilization review staff. Prepare reports and analyze utilization data trends. Required Qualifications Active California RN License Current AHA BLS Certification Minimum 2 years acute care RN experience At least 1 year Medical-Surgical nursing experience Minimum 1 year Utilization Review and/or Discharge Planning experience in an acute care hospital OR 2 years Case Management experience in a clinic, physician office, or alternative healthcare setting performing utilization review and discharge planning BI02

Pay:

$3,200.00 - $3,400.00 per week Application Question(s): Best time to connect

Experience:

acute care

RN:

3 years (Required) Utilization Review and/or

Discharge Planning:

2 years (Required)

License/Certification:

RN License (Required) BLS Certification (Required) Shift availability: Day Shift (Required)

Work Location:

In person