Registered Nurse (RN) | Case Manager
Location: Irvine, CA
Agency: Cynet Health
Pay: $2,806 per week
Shift Information: Days - 5 days x 8 hours
Contract Duration: 13 Weeks
Start Date: 11/17/2026
Job Title: Case Manager and Utilization Review RN Profession: Registered Nurse Specialty: Case Manager Duration: 13 weeks Shift: Day Hours per Shift: 8 hours Experience: 5 years required License: State License required Certifications: BLS, BSN Must-Have: Acute Client experience Long Term Acute Care/Rehab/Skilled Nursing experience Epic documentation experience InterQual documentation experience Description: Case Manager and Utilization Review RN for Cancer Specialty Client. Five years of experience is required. Utilize Epic and InterQual documentation. SBAR communication is essential. Weekends are required. BLS, BSN, and State License are mandatory certifications. Skills and experience required include: Acute Client experience. Understanding of Long Term Acute Care/Rehab/Skilled Nursing. Knowledge of Admission Criteria. Care Coordination expertise. Discharge Planning abilities. Application of InterQual Criteria. Utilization of Milliman Guidelines. Understanding of UR Admission Criteria. Experience with UR Appeals and Denials. UR Concurrent Review experience. UR Continued Stay Reviews knowledge. UR Medical Necessity expertise. UR Retrospective Review experience. Understanding of CMS guidelines. Familiarity with CPT coding and billing. Knowledge of the Department of Health regulations. Understanding of DRG (Diagnosis Related Groups). Familiarity with HEDIS measures. Knowledge of HIPAA guidelines. Experience with ICD 10 coding. Awareness of NCQA standards. Understanding of OSHA regulations. Knowledge of The Joint Commission Core Measure/National Safety Goals. Understanding of Workers Compensation regulations.
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