New

RN Case Manager (BHI Utilization Management )

22nd Century Technologies, Inc.
Pay Rate: $69.86 /hrs. On w2
United States, California, Orange
Oct 01, 2025
Job Title: RN Case Manager (BHI Utilization Management ) Location: Orange CA 92868 Duration: 6+ Months Shift: Monday through Friday, 7:00 a.m. - 3:30 p.m. Pay Rate: $69.86 /hrs. On w2 without benefits Role & Responsibilities: 85% - Utilization Management Services: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Reviews requests for medical appropriateness by using established clinical protocols to determine the medical necessity of the request. Responsible for mailing rendered decision notifications to the provider and member, as applicable. Screens inpatient and outpatient requests for the Medical Director's review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director's decision and documents follow-up in the utilization management system. Completes the required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any authorization updates. Reviews International Classification of Diseases (ICD-10), Current Procedural Terminology (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and the existence of coverage specific to the line of business. 10% - Administrative Support: Assists manager with identifying areas of staff training needs and maintains current data resources. 5% - Other: Completes other projects and duties as assigned. Minimum Qualifications: Associate degree in nursing (ADN) or related field PLUS 3 years of clinical experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Utilization management reviewer experience. Preferred Qualifications: Managed care experience. Behavioral health clinical experience. Required Licensure / Certifications: Current unrestricted Registered Nurse (RN) license to practice in the state of California required.