Travel RN Case Manager (Utilization Review)

Company: Kern Medical - 1700 Mount Vernon Ave.
Location: Bakersfield
Posted on: March 20, 2026

Job Description:

Job Description Certification Details - BLS - California RN License Job Details - Utilization Review Nurse II represents the fully experienced level in utilization review and discharge planning activities. - Obtains and evaluates medical records for in-patient admissions to determine if required documentation is present. - Obtains appropriate records as required by payor agencies and initiates Physician Advisories as necessary for unwarranted admissions. - Conducts on-going reviews and discusses care changes with attending physicians and others. - Formulates and documents discharge plans. - Provides on-going consultation and coordination with multiple services within the hospital to ensure efficient use of hospital resources. - Identifies pay source problems and provides intervention for appropriate referrals. - Coordinates with admitting office to avoid inappropriate admissions. - Coordinates with clinic areas in scheduling specialized tests with other health care providers, assessing pay source and authorizing payment under Medically Indigent Adult program as necessary. - Reviews and approves surgery schedule to ensure elective procedures are authorized. - Coordinates with correctional facilities to determine appropriate use of elective procedures, durable medical goods and other services. - Answers questions from providers regarding reimbursement, prior authorization and other documentation requirements. - Learns the documentation requirements of payor sources to maximize reimbursement to the hospital. - Keeps informed of patient disease processes and treatment modalities. - Level II teaches providers the documentation requirements of payor sources to maximize reimbursement to the hospital. - Level II may assist in training Utilization Review Nurse I's. - Knowledge of payor source documentation requirements and governmental regulations affecting reimbursement; knowledge of acute care nursing principles, methods and commonly used procedures; knowledge of common patient disease processes and the usual methods for treating them; knowledge of medical terminology, hospital routine and commonly used equipment; knowledge of acute hospital organization and the interrelationships of various clinical and diagnostic services. - Ability to effectively evaluate the medical records of hospital admissions regarding continuing stay necessity, appropriateness of setting, delivered care, use of ancillary services and discharge plans. - Ability to assess and judge the clinical performance of physicians and other health professionals. - Ability to communicate documentation needs in an effective and tactful manner that promotes cooperation. - Ability to teach co-workers what is needed and required in the medical record for reimbursement and audit purposes. - Ability to gather and analyze data and prepare reports and recommendations based thereon. - Ability to get along with physicians, other health providers, outside payor sources and the general public. - Performs other job related duties as assigned. Job Requirements - Possession of a valid license as a Registered Nurse in the State of California. - Level I: two (2) years of experience or its equivalent as a registered nurse in an acute care hospital, at least one (1) of which was on a medical/surgical ward or unit. - Level II: one (1) year of utilization review/discharge planning experience in an acute care hospital or as a Case Manager in an alternate medical setting such as a clinic or physician’s office performing utilization review or discharge planning. - Alternatively, possession of a valid license as a Registered Nurse in the State of California and five (5) years of experience as a Case Manager in an alternate medical setting such as a clinic or physician’s office performing utilization or discharge planning. - Incumbents may be required to possess and maintain specific certificates competency based on unit specific requirements as a condition of employment. Additional Details - Case management experience in California (excluding Kaiser), preferably more than 1 assignment. - Able to do both Utilization review and Care Coordination/Discharge planning. - Experience in acute care/ICU/ED units. - Extra: Trauma facilities experience. - Experience with teaching facilities.

Keywords: Kern Medical - 1700 Mount Vernon Ave., Palmdale , Travel RN Case Manager (Utilization Review), Healthcare , Bakersfield, California