RN - Utilization Review (Remote)
RN - Utilization Review (Remote)
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Duration: 13 Weeks
Pay Rate: $54/hr (W2) or $57/hr (1099)
- Schedule: Monday to Friday 5x8-Hour Days
- Hours: 08:00 AM 04:30 PM (PST)
- Weekend Requirement: Every third weekend
This role involves reviewing medical necessity documentation and level of care decisions across multiple hospitals and service lines.
- Perform utilization review for inpatient observation and extended outpatient cases
- Apply InterQual criteria (required Hardstop)
- Use Epic for documentation and review workflows (recent use within 6 12 months required)
- Interpret and apply Medicare rules and documentation (e.g. CC44s ABNs HINNs MCSNs)
- Rotate across three hospital systems under centralized UM
- Adhere to California labor laws (breaks meals and time reporting)
- Active CA RN License
- Minimum 3 years of acute care CM/UM experience in a hospital setting (not health plan or medical group)
- InterQual experience (Hardstop)
- Recent Epic use (within the last 6 12 months)
- Strong understanding of Medicare HMO and IPA processes
- High attention to detail organizational and communication skills
- Comfortable working independently in a fully remote environment
Employment Type
Full Time
