Registered Nurse RN Utilization Review / Discharge Planning

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Immediate need for a talented Registered Nurse – RN Utilization Review / Discharge Planning . This is a 06+ months contract opportunity with long-term potential and is located in San Jose, CA(Onsite). Please review the job description below and contact me ASAP if you are interested.

Job ID: 26-04824

Pay Range: $60 - $65/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

  • Utilization Management
  • Perform daily pre-admission, admission, and concurrent utilization reviews
  • Apply InterQual® and/or MCG® criteria to determine medical necessity and level of care
  • Assess readiness for discharge and continued stay
  • Educate care teams on utilization and care coordination processes
  • Case Management & Discharge Planning
  • Coordinate inpatient discharge planning and transitions of care
  • Participate in multidisciplinary rounds and care planning discussions
  • Arrange authorizations, transfers, and post-acute services
  • Ensure continuity of care through clear documentation
  • Regulatory & Compliance
  • Ensure compliance with CMS, DMHC, NCQA, TJC, HIPAA, ERISA, EMTALA
  • Accurately interpret and apply member healthcare benefits

Key Requirements and Technology Experience:

  • Key Skills; Inpatient Case Management & Discharge Planning
  • Utilization Management / Utilization Review (UM/UR)
  • Acute Hospital Care Coordination & Transitions of Care
  • Minimum 2 years of inpatient utilization management, case management, or discharge planning experience
  • Acute inpatient hospital experience required
  • Licensure & Certifications:
  • Active California RN License (Required)
  • BLS Certification (Required)
  • Schedule Details:
  • Shift: 8:00 AM – 4:30 PM
  • 5 days/week including every other weekend (Saturday & Sunday)

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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