Registered Nurse – Case Manager​/Utilization Manager

Job : 25-96149

Location: Santa Clara, CA (Onsite)

Employment Type: Contract (03+ Months)

Pay Range: $60.00/hr - $65.00/hr employee benefits include health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Immediate need for a talented Registered Nurse – Case Manager/ Utilization Manager
. This is a 03+ Months Contract opportunity with long-term potential and is located in Santa Clara, CA (Onsite). Please review the job description below and contact me ASAP if you are interested.

• Perform daily pre-admission, admission, and concurrent utilization reviews
• Determine appropriate levels of care using clinical guidelines and policies
• Coordinate inpatient discharge planning and transitions of care
• Participate in multidisciplinary rounds with physicians and care teams
• Communicate discharge plans with patients, families, and external providers
• Arrange transfers, post-acute services, and obtain authorizations as needed
• Ensure continuity of care through accurate documentation and follow-up
• Maintain compliance with federal, state, and institutional regulations
• Educate care teams on utilization and care coordination processes

• Acute hospital experience (inpatient setting)
• Knowledge of CMS, DMHC, NCQA, TJC, HIPAA, EMTALA
• Strong interdisciplinary communication and care coordination
• Ability to independently manage inpatient caseloads
• Healthcare benefit interpretation and authorization coordination
• Graduate of an accredited school of nursing
• Diploma or Associate Degree in Nursing (ADN) required
• BLS Certification (Required)
• Minimum 2 years of experience in: case management, recent acute inpatient hospital experience, ability to work rotating schedules and every other weekend, comfortable working in a labor/management partnership environment
• Bachelor’s degree in Nursing or healthcare-related field
• Master’s degree in Case Management

Not Applicable

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