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RN Case Manager - Utilization Review
Company : Prime Healthcare Services
Location : Lynwood, CA, 90262
Job Type : Full Time
Date Posted : 1 January 2026
Overview
St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the hospital for high quality and compassionate medical care. St. Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Surgical, Orthopedics, Obstetrics, Pediatrics, Behavioral Health, and Emergency and Trauma Care. In addition, the hospital offers a broad array of education and outreach programs that advance community health. St. Francis Medical Center is a Comprehensive Stroke Center, STEMI Receiving Center, ED Approved for Pediatrics, Geriatric ED, Level III Neonatal ICU, and Level II Trauma Center. Please visit www.stfrancismedicalcenter.com for more information. Join an award-winning team of dedicated professionals committed to compassion, quality, and service!
Responsibilities
Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.
Qualifications
EDUCATION, EXPERIENCE, TRAINING
1. Starting April 1 2015. Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred.4. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred.6. Experience and knowledge in basic to intermediate computer skills.
Pay Transparency
St. Francis Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time. The current compensation range for this role is $45.83 to $61.61. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Employment Status
Full TimeShift
EveningsEqual Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Privacy Notice
Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf
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Frequently asked questions
An RN Case Manager in Utilization Review must carefully evaluate medical necessity while advocating for optimal patient outcomes. They coordinate care plans that meet clinical standards within budget constraints, ensuring resources are used effectively without compromising quality, particularly in complex hospital settings like St. Francis Medical Center.
Besides a valid RN license, certifications such as Certified Case Manager (CCM) or specialized training in utilization review tools like Milliman or InterQual criteria can significantly boost expertise. These credentials deepen understanding of clinical guidelines and improve decision-making in case management roles.
Evening shifts often demand heightened vigilance for urgent admissions and rapid coordination with multidisciplinary teams. In a trauma center, RN Case Managers must swiftly review cases for medical necessity and ensure seamless transitions in care, balancing fast-paced demands with thorough utilization oversight.
RN Case Managers in Lynwood typically earn between $45.83 and $61.61 per hour, reflecting skills, certifications, and experience. Those with extensive acute care backgrounds and proficiency in utilization review criteria often negotiate salaries toward the higher end, aligning with regional healthcare compensation trends.
Lynwood's healthcare sector sees moderate demand for skilled RN Case Managers due to its diverse patient population and comprehensive facilities. Factors like proximity to Los Angeles, cost of living, and hospital certifications increase competition, making specialized experience and evening shift flexibility highly valuable.
Prime Healthcare Services emphasizes integrated care and cost containment within busy medical centers. RN Case Managers here often juggle extensive documentation, interdisciplinary communication, and adherence to proprietary utilization protocols, which may differ in approach and technology from other healthcare systems.
Yes, Prime Healthcare provides a benefits package that includes paid time off, 401(k) plans, and flexible voluntary options. These benefits help RN Case Managers manage demanding evening schedules by allowing customization of healthcare, retirement, and educational perks suited to individual needs.
Working at Prime Healthcare Services exposes RN Case Managers to a wide range of clinical specialties and high-acuity cases, fostering skill development. The organization's emphasis on quality and leadership can open pathways to supervisory roles or specialized certifications, enhancing professional growth in utilization review.
In Lynwood and the greater Los Angeles area, maintaining a current California RN license is mandatory. Additionally, certifications in Basic Cardiac Life Support (BCLS) and familiarity with regional utilization review standards like Milliman or InterQual criteria are highly regarded by employers.
Many assume the role is mostly administrative; however, it requires dynamic clinical judgment, patient advocacy, and real-time collaboration with providers. The workload involves detailed chart reviews, decision-making on care intensity, and ensuring timely discharge planning, especially critical in trauma care settings.