Registered Nurse Case Manager

Job Summary: The Registered Nurse Case Manager is responsible for utilization management, quality assurance, and discharge planning activities. The role aims to achieve quality outcomes, optimal care/cost management, and high customer satisfaction. This position requires active functioning as an RNCM with hands-on experience in inpatient care coordination, discharge planning, and post-acute clinical payer authorization.Location:Santa Barbara, California, United StatesResponsibilities: Perform utilization management, quality assurance, and discharge planning.Coordinate care to ensure quality outcomes and cost-effective services.Conduct inpatient care coordination.Manage discharge planning processes.Handle post-acute clinical payer authorizations.Utilize InterQual and Milliman guidelines for reviews.Conduct concurrent and retrospective reviews.Manage appeals and denials.Ensure compliance with regulatory standards (CMS, Department of Health, The Joint Commission, etc.).Perform CPT and ICD-10 coding and billing.Participate in data entry and documentation in EPIC.Answer phone calls and direct them accordingly.Coordinate equipment and supply needs.Required Skills & Certifications: Current California Nursing license in good standing.BLS certification.Associate's Degree in Nursing (ADN).Minimum of 2 years of direct patient care experience in an acute care setting.Knowledge of CMS, CPT, Department of Health, DRG, HEDIS, HIPAA, ICD-10 Coding, NCQA, OSHA, The Joint Commission, and Worker's Compensation regulations.Preferred Skills & Certifications: Bachelor's Degree in Nursing (BSN).Certification in Case Management.Previous experience as a case manager in an acute care setting.Special Considerations: Must be willing to float.Scheduling:5x8 hour shifts, 0730-1600, Monday through Friday, weekends off.Block scheduling type.