Registered Nurse (RN) - Utilization Review
Providence SoCal Shared Services Case Management
Utilization Management – Care Management
Shift options: 8:00–16:30 PST or 9:00–17:30 PST. Every third weekend rotation required. Must commit to working 3 of the following holidays: Thanksgiving, Christmas Eve, Christmas Day, New Year's Eve, New Year's Day.
Assignment Details
This is a 100% remote position.
Requirements
- 3 years of acute medical Care Management / Utilization Management experience in a hospital setting.
- Recent experience with Epic (within the last 6–12 months).
- Knowledge of Medicare regulations and processes.
- Proficiency in InterQual criteria.
- Valid CA state license required at submission.
Responsibilities
- Perform utilization review and medical necessity determinations, including concurrent, continued stay, and retrospective reviews.
- Conduct prior authorization and pre-certification processes.
- Familiarity with DRG/CPT coding and care coordination.
Compliance / Notes
1-week orientation required. Pre-approved time off is limited, and must be requested in advance. Overtime must be approved by leadership.
Vacancy posted 1 day ago
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