RN Utilization Review

ob Title: Remote Registered Nurse- Utilization Review Case Manager
Location: Torrance CA
Schedule: Day (5x8 Hours) 8:00am to 4:30pm
Position Type: 8 weeks contract (with possible extension)

Job Summary:

The Utilization Review Case Manager RN is responsible for performing utilization review activities to ensure appropriate level of care medical necessity and compliance with regulatory and payer guidelines. This role collaborates with physicians care teams and payers while working remotely after initial onboarding.

Schedule & Hours

• Shift: Day Shift
• Hours: 5 8-hour shifts (08:00 AM 4:30 PM)
• Weekly Hours: 40 hours

Key Responsibilities

• Perform utilization review for inpatient and outpatient cases across all age groups
• Apply InterQual criteria to assess medical necessity and level of care
• Conduct concurrent and retrospective reviews as assigned
• Collaborate with physicians nursing staff and interdisciplinary care teams to support appropriate care decisions
• Communicate with payers and insurance providers as needed
• Document reviews accurately and timely in EPIC Indicia and related systems
• Participate in virtual meetings trainings huddles and observation reviews via WebEx
• Ensure compliance with hospital policies regulatory standards and payer requirements
• Maintain productivity and quality standards in a remote environment

Qualifications:

Required:

• Active Registered Nurse (RN) license
• Minimum 3 year of Utilization Review / Case Management experience
• Strong clinical judgment and analytical skills
• Excellent written and verbal communication skills
• Ability to work independently in a remote setting

Equipment Requirements

• Must provide own desktop or laptop

Additional monitor/screen strongly recommended for efficiency