Registered Nurse (RN) - Utilization Review

Utilization Management – Care ManagementScheduleShift: 8:00–16:30 or 9:00–17:30 PST. Weekend rotation: every third weekend. Must commit to working 3 of the 5 major holidays: Thanksgiving, Christmas Eve, Christmas Day, New Year's Eve, New Year's Day.Assignment Details100% remote position supporting a centralized UM team for multiple facilities.RequirementsValid California state license required.3 years acute medical Care Manager/Utilization Management experience in a hospital setting.Recent experience with Epic within the last 6–12 months.Knowledge of Medicare regulations is required.Experience with utilization review, prior authorization, and pre-certification processes.Experience using InterQual criteria.Knowledge of care coordination, discharge planning, DRG, and CPT basics required.Experience with HMOs/IPAs is a plus.ResponsibilitiesPerform utilization reviews, both concurrent and retrospective.Conduct prior authorization and pre-cert processes.Ensure compliance with Medicare/Medicaid regulations and related UM processes.Utilize InterQual criteria effectively in reviews.Collaborate with care coordination and discharge planning teams.Monitor and manage patient care across service lines including inpatient, extended hospital outpatient, and observation.Compliance / NotesOrientation is 40 hours. Must provide required requests for time off and scheduling up front at submission. Background checks will be conducted, and references covering the last year are required.