Travel RN Case Manager, Utilization Review
| Estimated Pay info | Based on similar jobs in your market$53 per hour |
|---|---|
| Hours | Full-time, Part-time |
| Location | Ventura, California |
About this job
Job Description
American Traveler is seeking a travel nurse RN Case Management for a travel nursing job in Ventura, California.
Job Description & Requirements- Specialty: Case Management
- Discipline: RN
- Start Date: 07/06/2026
- Duration: 13 weeks
- 40 hours per week
- Shift: 8 hours, days
- Employment Type: Travel
- Shift: Days, 5x8hrs
- Hours: 40 hrs/wk
- Start Date: Jul 6, 2026
- Length: 13 weeks
- Openings: 1
American Traveler is seeking an experienced RN Case Manager for a hospital-based utilization review role requiring strong MCG proficiency and a minimum of 3 years of acute care CM/UR experience in Ventura County, CA.
Details- Hospital setting with an average daily census of 180 patients
- Patient population spans adolescents through geriatrics
- Case Management/Utilization Review unit
- Day shift schedule: Monday–Friday, 8:30 AM–5:00 PM (5x8 hours)
- Every other weekend required, totaling 4 weekend shifts over 4 weeks
- EMR: Cerner; communication framework: SBAR
- Case management module used for concurrent documentation, tracking, and outcome recording
- Active CA RN license required
- Current BLS certification required
- CCM or other case management certification preferred
- Minimum 3 years of acute care Case Management/Utilization Review experience required
- Strong proficiency in utilization review using MCG guidelines required
- Thorough understanding of the Two Midnight Rule required
- Experience with Cerner EMR preferred
- 2 professional supervisor references from within the past 2 years required for consideration
- Full 7-year work history with all gaps explained required for consideration
- Performs concurrent utilization review using MCG guidelines to validate patient status and medical necessity
- Applies evidence-based screening criteria for admission, continued stay, and discharge reviews
- Ensures appropriate level-of-care status for all bedded outpatient services requiring hospital admission
- Provides clinical reviews to health plans and responds to payer requests in a timely manner
- Educates physicians and the care team on patient status changes, including transitions from observation to inpatient
- Coordinates concurrent Peer-to-Peer calls and participates in the appeals process as needed
- Adheres to regulatory procedures including MOON, IMM Discharge, Appeal/HINN, Code 44, and Inpatient Only Procedure guidelines
- Collaborates with case managers and payers to ensure authorizations are obtained and current
- Assists with denial management to identify process improvement opportunities
- All time-off and scheduling requests must be submitted at the time of initial consideration
American Traveler Job ID #P-719728. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel RN - Case Management/Utilization Review - Case Management
About American TravelerWith over 25 years of experience, American Traveler has established a reputation for outstanding customer service. Our team ensures a smooth, worry-free experience for those starting on or expanding their travel nursing and allied careers.
With thousands of travel nursing and allied jobs nationwide, our attentive and approachable recruiters find positions that align perfectly with your career aspirations and personal requirements.
American Traveler offers exceptional benefits, including premium medical, dental, vision and life insurance beginning day one of your assignment, generous 401(k) match, substantial housing stipends, and more. Additionally, with 24/7 support and access to our in-house clinicians, you are assured confidence and comfort throughout your assignment.
With our team behind you, you can relax and enjoy a rewarding travel career.
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