Travel Nurse (RN) - Case Management

Pre-employment modules may be required for this role. Please upload any certifications or health documents you have to your profile to expedite your on-boarding process.

Additional Details:

Required Skills/Experience: Minimum Experience: 1 - 3 years of directly related RN experience. Must have inpatient CM experience. Community Hospital Experience.

Acute Hospital Case Management/Utilization Review Admission Criteria Benefits Eligibility Care coordination Concurrent Review Continued Stay Reviews Data Abstraction Determine Medical Necessity per Evidence-Based Guidelines Discharge Planning Disease management Needs Assessment/ Order DME Plan of Care Utilize InterQual Criteria Utilize Milliman Guidelines Utilization Review Admission Criteria Concurrent Review Continued Stay Reviews Data Abstraction Medical Necessity Utilize InterQual Criteria Utilize Milliman Guidelines SDU/PCU/IMC/Obs Regulatory CMS: Centers for Medicare and Medicaid Services Acute Hospital Experience by Specialty DRG (Diagnosis Related Groups)

Preferred Skills/Experience: Teaching Hospital Experience. LTAC Experience.

Ambulatory* Behavioral Health* Home Health* Hospice* Insurance Company* Long Term Acute Care/Rehab/Skilled Nursing* Telephonic* Appeals and Denials* Audits* Disability case management* Pre-Cert Review* Prior Authorizations* Worker’s comp case management* Appeals and Denials* Audits* CPT (Current Procedural Terminology) coding and billing* Pre-Cert Review* Prior Authorization* Quality Improvement* Retrospective Review* Behavioral Health* ER* ICU* MS NICU* Surgical Services* Womens Services* CPT (Current Procedural Terminology) coding and billing* Department of Health* DRG (Diagnosis Related Groups) HEDIS (The Healthcare Effectiveness Data and Information Set) Measures* HIPAA guidelines (Health Insurance Portability and Accountability Act) ICD 10 Coding* NCQA (National Committee for Quality Assurance)* OSHA: Occupational Safety and Health Administration* The Joint Commission/ Core Measure/National Safety Goals* Worker’s Compensation*

Required Credentials: Drivers License/State ID.

Types of Patients on Unit: Patient Age Groups: Neonates, Infants, Adults, Geriatrics

**Unit/Facility Details:**Pre-Approved Time Off: 1 Request.

Shift & Scheduling: Weekend Coverage: Every Other. Number of Weekend Shifts Per Contract: Every other - 12

Floating Requirements: Units and to sister hospital, Palomar Health, Poway.