RN Case Manager

Pride Health • Los Angeles, CA, United States

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Job Title : RN Case Manager

Location : Tarzana, California, 91356

Contract duration : 13 weeks

Shift : 5X8 -hours

Schedule : Days

Key Responsibilities :

Perform comprehensive case management duties including assessment, planning, implementation, coordination, and evaluation of patient care.
Collaborate with physicians, nursing staff, social workers, and other members of the healthcare team to develop individualized discharge plans and ensure continuity of care.
Conduct utilization reviews to determine the medical necessity of admissions and continued stays using InterQual or Milliman Guidelines .
Facilitate communication between payers, patients, and healthcare providers to optimize benefits utilization and minimize denials.
Manage a caseload of up to 25 patients daily, ensuring timely and efficient transitions of care.
Support quality improvement initiatives and adherence to hospital and regulatory requirements (CMS, The Joint Commission, NCQA, OSHA, HIPAA).
Participate in weekend rotation coverage (every other weekend) as part of the Case Management team.
Document all case management activities accurately in Epic EMR .
Utilize evidence-based guidelines to determine medical necessity and appropriate levels of care.
Assist patients and families in navigating available resources and benefits , including DME, home health, rehabilitation, and community services.

Requirements :

Active RN License (State of California).

Minimum 2 years of acute care hospital experience required.

Experience in both Utilization Management and Care Coordination (discharge planning).

Prior travel experience preferred.

Epic EMR experience required.

Strong knowledge of CMS regulations, InterQual, and Milliman Guidelines .

Interested? Apply now!

About Pride Health :

Pride Health is Pride Global healthcare staffing branch, providing recruitment solutions for healthcare professionals and the industry at large since 2010.

Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

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Rn Case Manager • Los Angeles, CA, United States