Job Details

Job Summary:
Seeking an experienced in-patient Case Manager with Utilization Review expertise to assess and coordinate patient care, ensuring appropriate utilization and discharge planning. This role requires strong clinical assessment skills and knowledge of healthcare regulations.

Responsibilities:

• Conduct detailed chart reviews and assess patient status using Severity of Illness (SI) and Intensity of Service (IS) criteria.
• Monitor observation cases to ensure timely discharge or appropriate admission referrals.
• Initiate and document Medi-Cal Treatment Authorization Requests (TARs) promptly upon admission or as needed.
• Educate healthcare providers on utilization management policies and criteria to optimize patient care.
• Prepare documentation for appeals and communicate denial letters to patients and physicians.
• Identify and escalate improper bed utilization or quality of care issues to the Utilization Management physician advisor.

Qualifications:

• Hold an active California RN license.
• Possess at least two years of clinical nursing experience.
• Have a minimum of two years of Case Management experience or relevant certification.
• Maintain current BLS certification.

Benefits & Growth:

• Gain valuable experience in hospital-based case management, expanding your clinical and administrative skill set.
• Work within a supportive team environment committed to professional development and quality patient care.

• Day 1 Medical, Dental, and Vision insurance
• Travel reimbursement for assignments
• Paid sick leave and additional valuable benefits
• Access to our $1,000 Inspire a Friend Referral Program

Choosing TactStaff means partnering with a team that understands the unique demands and rewards of Case Management - Hospital. We're here to provide you with meaningful assignments that support your professional growth while ensuring each role is a step toward achieving your long-term career goals.

Apply today to experience how TactStaff can elevate your Case Management - Hospital career!