Travel Nurse RN - Case Manager - $3,052 per week in Sacramento, CA

TravelNurseSource is working with Cynet Health to find a qualified Case Manager RN in Sacramento, California, 95833!

Pay Information

$3,052 per week

About The Position

Job Title : Case Manager

Profession : Registered Nurse

Specialty : Utilization Management

Duration : 24 weeks

Shift : Day

Hours per Shift : 8 hours (08 : 00 - 16 : 30)

Experience : Minimum of 2 years of acute / inpatient case management experience required

License : Current Registered Nurse License required

Certifications : AHA or American Red Cross certifications required

Must-Have : Epic charting system experience preferred

Description :

Conduct preauthorization, concurrent, and retrospective utilization management review using accepted criteria for ambulatory, acute, and post-acute patients to confirm medical necessity.

Coordinate utilization management, resource management, discharge planning, post-acute care referrals, and care facilitation.

Promote patient wellness, improved care outcomes, and efficient utilization of health services among a patient population with complex health needs.

Provide inpatient and ambulatory referral review, managing prior authorizations and retrospective referrals as documented.

Process referrals based on application of criteria such as Medicare, MCG, and InterQual.

Collaborate with medical directors routinely regarding referrals and cases not meeting criteria.

Issue appropriate authorization and denial letters as needed.

Work collaboratively with staff to handle daily tasks.

Document all referral activities thoroughly.

Conduct preauthorization, concurrent, and retrospective review for acute hospitalized and post-acute patients.

Consult with facility care teams to develop goals to enhance functional status, identify discharge planning needs, and ensure continuity of care.

Document applicable guidelines and rationale for cases not meeting criteria, routing to the medical director for further review.

Issue and document facility or regulatory letters as applicable.

Actively participate in interdisciplinary meetings in acute or post-acute settings.

Facilitate repatriation of out-of-network patients and escalate as necessary.

Identify and refer patients to value-based case management teams as appropriate.

Comply with health plan and regulatory prior authorization turnaround timeframes.

Understand health plan contracts and associated responsibilities.

28751646EXPPLAT

Job Requirements

Required for Onboarding

• ACLS
• BLS
• Pharmacology
• Skills Checklist
• Specialty Exam

About Cynet Health

Your travel nursing adventure begins here. Matching talented nurses like you with high-paying travel jobs at the best facilities across all 50 states. We offer the most competitive pay for every position we fill. We understand this is a partnership. You will have no surprises. Your salary will be discussed upfront and there will be no troubling negotiation tactics.