Commute Time
Date Posted
Title
Job Type
Benefits
Pay
3040 Case Manager Rn jobs in Santa Ana,CA
Care Manager RN
Providence Health and Services
Anaheim, CA 92816
Health InsurancePaid Time OffRetirement Benefit
New, Posted just now
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RN Case Manager, Full time, Days
PIH Health
Whittier, CA 90602
~ 34 min Onsite
- Excellent verbal, written, and organizational skills required.
- Must be able to demonstrate sound decision making and prioritization skills.
- Minimum of 5 years hospital nursing experience
- Maintain an active California RN License.
- Knowledge of medical terminology and current third party payor reimbursement methodologies.
- Proficiency with main-frame and personal computers.
- Ability to follow chain of command.
- Self-motivated and results oriented.
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Travel Nurse RN - Case Management - $3,019 per week
Lancesoft
Irvine, CA 92620
$3,019/wk
Urgently Hiring
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Travel Nurse RN - Case Management - $2,621 per week
trustaff
Orange, CA 92867
$2,621/wk
Urgently HiringHealth InsuranceRetirement Benefit
Higher-Hire
Customer Care Specialist - Work From Home
Carrum Health
Tustin, CA 92780
$26/hr
RemoteFlexible ScheduleHealth InsurancePaid Time OffRetirement Benefit
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Travel Nurse RN - Case Management - $2,817 per week
Olaro
Irvine, CA 92620
$2,817/wk
Urgently Hiring
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Local Contract Nurse RN - Case Management - $68-72 per hour
Apidel Technologies
Irvine, CA 92620
$68-$72/hr
Urgently HiringEducation AssistanceHealth InsurancePaid Time OffRetirement Benefit
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Travel Nurse RN - Case Manager, Utilization Review - $2,479 per week
Travel Nurses
Orange, CA 92867
$2,479/wk
Urgently HiringEducation AssistanceHealth InsuranceRetirement Benefit
New, Posted 1 day ago
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General Manager - Extended Stay Hotel + Full Benefits
ESA Management, LLC
Newport Beach, CA 92660
~ 24 min OnsiteUrgently HiringBilingual PreferredHealth InsurancePaid Time OffRetirement Benefit
- Read, write and speak English and comprehends basic instructions.
- Minimum three years related hospitality management (or related field) experience required; Customer experience required.
- Must have a valid driver's license and successfully pass a motor vehicle check.
New, Posted 1 hour ago
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Travel Nurse RN - Utilization Review - $2,507 per week in Orange, CA
TravelNurseSource
Orange, CA 92866
$2,507/wk
~ 16 min Onsite
- Assess the medical necessity of procedures, tests, and treatments to ensure they align with established guidelines and criteria, such as those from the InterQual or Milliman Care Guidelines
- Identify potential barriers to discharge and collaborate with the interdisciplinary team to address these issues and facilitate a timely discharge
- Educate staff and providers on the importance of utilization review processes, medical necessity criteria, and compliance with payer requirements
- Work closely with insurance companies, managed care organizations, and government payers (e.g., Medicare, Medicaid) to review cases for coverage, authorization, and reimbursement
- Provide recommendations or alternative care options to improve patient outcomes and optimize resource utilization
- Prepare reports on utilization metrics, including patterns in hospital admissions, readmissions, and discharge delays, for management and leadership review
- Communicate with healthcare teams to discuss any discrepancies or concerns regarding the utilization of resources, care plans, or treatment goals
- Monitor patient length of stay (LOS) to identify potential delays in discharge and ensure that patients are not staying in the hospital longer than necessary
- Maintain up-to-date knowledge of healthcare regulations, coding guidelines (ICD-10, CPT), and payer-specific policies to ensure accurate documentation and compliance
- Provide detailed, evidence-based rationales for medical necessity determinations and collaborate with the healthcare team to ensure compliance with UR protocols
- Resolve any issues related to denied claims or requests for additional documentation to ensure that services are covered by insurance providers
- Recommend the appropriate level of care (e.g., inpatient, outpatient, skilled nursing facility) based on clinical findings and guidelines
- Submit necessary documentation and justification to insurance companies to support medical necessity determinations and secure prior authorization for treatments, procedures, or extended hospital stays
- Work with case management teams to develop appropriate discharge plans, ensuring that the patient is ready for discharge and has the necessary resources and follow-up care
- Stay current on the latest healthcare policies, clinical guidelines, and best practices for utilization management
- Review patient medical records, treatment plans, and clinical data to assess the appropriateness of the care being provided and the necessity for continued hospitalization or services
- Assist with audits to evaluate the efficiency and accuracy of utilization management processes, making improvements where necessary
- Document findings from utilization reviews in the appropriate systems and ensure accurate record-keeping for insurance purposes and quality improvement efforts
- Registered Nurse (RN)
- Collaborate with physicians, case managers, and other healthcare professionals to ensure that patient care plans are appropriate and cost-effective
- Evaluate whether the care provided is appropriate, efficient, and meets the standards of care based on clinical evidence
- Perform retrospective and concurrent review of patient cases to determine if the level of care aligns with guidelines and if resources are being utilized efficiently
- Participate in continuing education and training programs related to UR, case management, or quality improvement initiatives
- Utilization Review
- Ensure that utilization review practices comply with regulatory standards, including The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other state or federal regulations
- Provide feedback to clinicians and healthcare teams regarding any areas for improvement in care planning or resource utilization
What companies are hiring Case Manager Rn jobs in Santa Ana,CA?
- Providence Health and Services
- PIH Health
- Lancesoft
- trustaff
- Carrum Health
- Olaro
- Apidel Technologies
- Travel Nurses
- ESA Management, LLC
- TravelNurseSource
- Providence Health and Services
- PIH Health
- Lancesoft
- trustaff
- Carrum Health
- Olaro
- Apidel Technologies
- Travel Nurses
- ESA Management, LLC
- TravelNurseSource
What is the hourly salary range for Case Manager Rn jobs in Santa Ana,CA?
The hourly salary range is $26 - $72.
The hourly salary range is $26 - $72.
