Registered Nurse – RN Utilization Review / Discharge Planning

Immediate need for a talented Registered Nurse – RN Utilization Review / Discharge Planning. This is a 06+months contract opportunity with long-term potential and is located in Santa Jose, California (Onsite). Please review the job description below and contact me ASAP if you are interested. 

Job ID: 24-22303

Pay Range: $60- $65/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
• Perform daily pre-admission, admission, and concurrent utilization reviews
• Apply InterQual® and/or MCG® criteria to determine medical necessity and level of care
• Assess readiness for discharge and continued sta
• Educate care teams on utilization and care coordination processes
• Case Management & Discharge Planning
• Coordinate inpatient discharge planning and transitions of care
• Participate in multidisciplinary rounds and care planning discussions
• Arrange authorizations, transfers, and post-acute services
• Ensure continuity of care through clear documentation
• Regulatory & Compliance
• Ensure compliance with CMS, DMHC, NCQA, TJC, HIPAA, ERISA, EMTAL
• Accurately interpret and apply member healthcare benefits

Key Requirements and Technology Experience: 

• Key Skills;Minimum 2 years of inpatient utilization management, case management, or discharge planning experience
• Acute inpatient hospital experience required
• Licensure & Certifications:
• Active California RN License (Required)
• BLS Certification (Required)

Our client is a leading Healthcare organization 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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