Travel RN
- Case Management/Utilization Review
- Case Management American Traveler
- 4.
0 Ventura, CA Job Details Contract $2,596.35 a week 19 hours ago Qualifications RN License BLS Certification Managing patients as a nurse case manager Acute care facility experience Utilization management Resource utilization in healthcare Milliman Care Guidelines (MCG Health)
Full Job Description Assignment Overview Shift:
Days, 5x8hrs
Hours:
40 hrs/wk
Start Date:
Jul 6, 2026
Length:
13 weeks
Openings:
1 Description American Traveler is seeking an experienced RN Case Manager for a hospital-based utilization review role requiring strong MCG proficiency and a minimum of 3 years of acute care CM/UR experience in Ventura County, CA. Details Hospital setting with an average daily census of 180 patients Patient population spans adolescents through geriatrics Case Management/Utilization Review unit Day shift schedule: Monday-Friday, 8:30 AM-5:00 PM (5x8 hours) Every other weekend required, totaling 4 weekend shifts over 4 weeks
EMR:
Cerner; communication framework: SBAR Case management module used for concurrent documentation, tracking, and outcome recording Requirements Active CA RN license required Current BLS certification required CCM or other case management certification preferred Minimum 3 years of acute care Case Management/Utilization Review experience required Strong proficiency in utilization review using MCG guidelines required Thorough understanding of the Two Midnight Rule required Experience with Cerner EMR preferred 2 professional supervisor references from within the past 2 years required for consideration Full 7-year work history with all gaps explained required for consideration Additional Information Performs concurrent utilization review using MCG guidelines to validate patient status and medical necessity Applies evidence-based screening criteria for admission, continued stay, and discharge reviews Ensures appropriate level-of-care status for all bedded outpatient services requiring hospital admission Provides clinical reviews to health plans and responds to payer requests in a timely manner Educates physicians and the care team on patient status changes, including transitions from observation to inpatient Coordinates concurrent Peer-to-Peer calls and participates in the appeals process as needed Adheres to regulatory procedures including
MOON, IMM
Discharge, Appeal/HINN, Code 44, and Inpatient Only Procedure guidelines Collaborates with case managers and payers to ensure authorizations are obtained and current Assists with denial management to identify process improvement opportunities All time-off and scheduling requests must be submitted at the time of initial consideration
