Case Manager

Remote Utilization Management RN

Job Title: Remote Utilization Management RN

Profession: Registered Nurse

Specialty: Utilization Review

Duration: 13 weeks

Shift: Day 5x8-Hour Hours per Shift: 08:00 - 16:30

Experience: 3 years in acute medical care management or utilization management in a hospital setting.

License: Must have a valid California nursing license.

Certifications: Experience with InterQual criteria and Medicare regulations is required. Must have experience with Epic charting system. Must have knowledge of admission criteria and medical necessity determination per evidence-based guidelines. Must have understanding of CMS regulations and HIPAA guidelines.

Description: The position involves utilization review responsibilities in a remote setting. A laptop, keyboard, and mouse will be provided. Candidates should have experience with acute hospital care and care coordination. Responsibilities include concurrent reviews, continued stay reviews, and prior authorizations. Knowledge of CPT coding and billing is required. Candidates will work with a variety of adult and pediatric acute and chronic diagnoses. Flexibility to support multiple facilities may be required. Candidates must commit to a rotation of weekend shifts every third weekend. Adherence to all labor laws is crucial, including regulations regarding breaks. Availability to work in Pacific Standard Time is necessary. Candidates must be prepared to float between different facilities if required. Must be willing to request all time off in advance during submission processes. References are required to verify prior experience in relevant roles. A hard stop exists for the necessity of the California license and recent experience with InterQual and Epic.

Benefits: We offer competitive benefits, including:

• Medical, dental & vision insurance
• Free and unlimited continuing education units (CEUs)
• 24/7 dedicated Care Line and clinical liaison support
• Personalized career consultant and "single point of contact" service
• Industry‑leading pay rates, loyalty rewards & referral bonuses
• Free tax return assistance for travelers
• 401(k) Retirement Plan
• Health Savings Account (HSA)
• Disability Insurance (Short-Term and Long-Term)
• Life and AD&D Insurance
• Paid Sick Leave (where required by applicable state or local law)
• Supplemental Insurance Plans
• Identity Theft Protection
• Pet Insurance
• Employee Wellness Programs
• Employee Assistance Program (EAP)
• Career Growth and Professional Development Opportunities

Disclaimer: Benefits eligibility, accrual rates, and usage limits may vary based on employment status, length of service, and work location. Paid Sick Leave is provided in strict accordance with applicable state and municipal mandates. Cynet Health reserves the right to modify, amend, or terminate any benefit plans at any time in accordance with applicable laws.

About Cynet Health: Cynet Health is a Joint Commission-accredited, Minority-Owned healthcare staffing agency headquartered in Sterling, Virginia, proudly serving healthcare facilities across the United States since its founding in 2010. As one of the nation's largest and fastest‑growing healthcare staffing firms in the nation, we staff thousands of nursing, allied health, locum tenens, pharmacy, therapy, direct‑hire, and non‑clinical professionals across hospitals, clinics, long‑term care facilities, labs and more. We're one of the most decorated staffing agencies in America-ranked a Top Travel Nursing Company by BluePipes, recognized among the fastest‑growing and most diverse staffing firms by Inc. 5000, Staffing Industry, WBJ and USPAACC-and remain deeply committed to excellence, inclusion, and community impact.

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