Medical Case Manager

Job Title: Medical Case Manager (As-Needed/Temporary)

Location : Orange CA 92868

Duration: Up to 6 Months

Schedule: Monday–Friday, 8:00 AM–5:00 PM

Work Arrangement: Fully Onsite

Job Summary

Seeking a licensed Medical Case Manager to support behavioral health utilization management, review medical necessity, coordinate care, and ensure compliance with clinical guidelines and documentation requirements.

Key Responsibilities

• Review inpatient and outpatient requests for medical necessity using established clinical criteria.
• Screen cases for Medical Director review and communicate decisions to providers and members.
• Maintain accurate documentation in utilization management systems.
• Coordinate Transition Care Management (TCM) activities.
• Review ICD-10, CPT, and HCPCS codes for accuracy and coverage.
• Identify utilization concerns, complaints, and authorization updates.
• Support administrative tasks, data tracking, and departmental initiatives.

Requirements

• Current unrestricted California license: LCSW, LPCC, LMFT, or RN.
• Minimum 3 years of clinical experience.
• Utilization Management Reviewer experience required.
• Managed care and behavioral health experience preferred.
• Strong communication, analytical, documentation, and organizational skills.