#RN2025

Medical Case Manager (RN – Behavioral Health Utilization Management)

Location: On-site – Full Office | Orange, California (must have active CA RN license)

Schedule: Monday to Friday | 7:00 AM – 3:30 PM

Salary Range: ($43 – $65/hr)

Department: BHI – Behavioral Health Utilization Management

Job Type: Temporary (Z Temp) | Full-Time

About The Role

Join a mission-driven team focused on serving communities with compassion, dignity, and respect. As a Medical Case Manager (RN), you'll support Behavioral Health Utilization Management efforts through clinical review, coordination, and administrative functions. You’ll help ensure members receive appropriate, timely, and high-quality care.

Key Responsibilities

Utilization Management (85%)

Review medical requests for appropriateness using established clinical protocols.
Coordinate with Medical Directors on review cases and relay decisions to providers/members.
Ensure accurate documentation and data entry into UM systems.
Collaborate with health networks, providers, and customer service teams.
Support Transition Care Management (TCM) activities.
Review ICD-10, CPT, and HCPCS codes for authorization and coverage validation.

Administrative Support (10%)

Support leadership in identifying training needs and maintaining reference materials.

Additional Duties (5%)

Perform other related responsibilities and projects as assigned.

Requirements

Minimum Qualifications:

Associate degree in Nursing (ADN) or related field.
At least 3 years of clinical RN experience.
Experience as a Utilization Management reviewer.
Active and unrestricted California RN license.

Preferred

Experience in a managed care environment.
Behavioral health clinical experience.

Skills & Competencies

Strong communication and documentation skills.
Ability to manage multiple tasks in a fast-paced environment.
Proficient with Microsoft Office and clinical review systems.
Capable of building relationships with diverse stakeholders.

Work Environment

Office-based with standard business hours.
Occasional travel or flexibility may be required depending on department needs.
Moderate noise level with no hazardous conditions.

Interested?

Submit Your Updated Resume Directly Or Email

Ashu

Senior Healthcare Recruiter

Direct: 510-455-4427

Email: Ashu@arohatechnologies.com

www.arohatechnologies.com

Aroha Technologies Inc., 5000 Hopyard Rd, Suite 415, Pleasanton, CA – 94568

Aroha Technologies, Inc

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