RN - Case Manager
Listed on 2026-08-06
-
Nursing
RN Nurse, Healthcare Nursing, Clinical Nurse Specialist, Nurse Practitioner
RN - Case Manager
Profession: Nursing
Specialty: Utilization Review RN
Duration: 13 weeks
Shift: Monday - Friday
Hours per Shift: 8 am - 5 pm
Experience: Minimum of 3 years of clinical nursing experience
License: Current and unrestricted Professional Nursing License in any U.S. state, territory, or Commonwealth
Certifications: Basic Life Support (BLS) certification by the American Heart Association (AHA)
Must-Have:
- Bachelor’s Degree in Nursing
- Demonstrated knowledge of case management, referred care, and utilization review processes
- Knowledge of electronic health record systems
Description:
The Utilization Review Nurse ensures that patients receive appropriate care by verifying medical necessity.
They confirm the correct patient status and monitor the ongoing need for services.
The role involves working to reduce unnecessary length of stay and prevent delays.
They support accurate clinical documentation for proper reimbursement.
The nurse coordinates with providers and the care team on discharge planning and transitions.
They manage resource use to control costs and communicate with payers to prevent denials.
Ensuring compliance with regulatory requirements is essential.
Contributions to reporting and quality improvement efforts are also part of the position.
They serve as a key liaison between clinical care, finance, and regulatory requirements.
The role directly impacts patient outcomes, hospital efficiency, and the organization's financial performance.
(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).