Registered Nurse Utilization Review Case Manager

San Diego, CA 92121

Employment Type: Direct Job Category: Registered Nurse RN Job Number: 46235

We are searching for a UM Review/CM Registered Nurse to join the RN Case Management team for an established managed care organization. This is a full time, permanent role and an office-based position. The hours are Monday-Thursday 6:30AM to 5:00PM (4 day work week!!!!). This position offers a competitive salary, comprehensive benefits package, generous PTO, and 401K company match.

As a Case Management Nurse you will:

  • Ensure proper utilization of services by assessing the needs and identifying solutions that promote quality and cost-effective care.
  • Conduct Quality Assurance reviews as necessary.
  • Determine medical appropriateness of services by evaluating medical guidelines, benefit determination and compliance with state mandated regulations based on Milliman and/or InterQual criteria.
  • Identify solutions to problems and non-standard requests
  • Maintain compliance with regulatory agency requirements
  • Collaborate with staff, physicians, and other members of the interdisciplinary team to coordinate and provide the level of care necessary to meet health needs


  • Current California Registered Nurse license
  • Knowledge of managed care organization/IPA/health plan Registered Nurse case management preferred
  • 2+ years of Registered Nurse clinical nursing experience in a clinical, acute care, or community setting
  • CCM Preferred
  • Utilization Management UM and/or Utilization Review UR Experience Preferred

Why Work Here:

  • Competitive starting pay
  • Comprehensive benefits package including PTO, Sick Pay, Holiday Pay, 401K w/match, Med/Den/Vis/Life Insurance, Short/Long Term leave, etc.
  • Very large and growing organization with several opportunities for advancement
  • Consistent, standard 40 hour work week only 4-day work week! Mon Thurs, 6:30 am to 5:00 pm
  • Opportunity to work among interdisciplinary team as well as independently in a fast-paced, educational environment
  • Ability to manage care for variety of those in need

This is a direct-hire, permanent, full-time position with a 4-day work week, Mon - Thurs, working 4 10 hour shifts, an established and growing healthcare organization. Please submit your resume to Kasey at to learn more about our client!

Apply Online
Apply with LinkedIn Apply with Facebook

Send an email reminder to:

Share This Job:

Related Jobs:

Login to save this search and get notified of similar positions.