RN - Case Manager

Remote Utilization Management RN

Job Title: Remote Utilization Management RN

Profession: Registered Nurse

Specialty: Utilization Review

Duration: 13 weeks

Shift: Day

Hours per Shift: 8 hours (08:00 - 16:30)

Experience: Minimum of 3 years of acute medical Care Manager/Utilization Management experience performing utilization review in a hospital setting

License: Must have a valid California nursing license

Certifications: Required certifications as per specialty

Must-Have:

• Proficiency with InterQual criteria
• Experience with Medicare regulations and specific Utilization Management processes
• Proficiency in Epic with recent use required within the last 6-12 months

Description: This position is fully remote. The job requires working Pacific Standard Time hours. It includes a variety of service lines and levels of care such as inpatient, extended hospital outpatient, and observation services. Candidates must demonstrate compliance with all California labor laws regarding breaks and lunches. There is a requirement to work every third weekend for the duration of the contract. Flexibility is essential, as caregivers will rotate between multiple facilities. All necessary computer equipment will be provided. Candidates must possess knowledge of admission criteria, concurrent review, and prior authorization processes. Experience with acute hospital care and understanding of CMS (Centers for Medicare and Medicaid Services) guidelines is required. Successful candidates will be skilled in determining medical necessity based on evidence-based guidelines. Communication with various interdisciplinary teams and a strong understanding of patient care protocols are essential for this position. The role mandates strict adherence to confidentiality policies involving HIPAA guidelines. Candidates should be able to manage a caseload effectively while ensuring high-quality patient care. References covering relevant experience within the last three years are required prior to employment. Candidates who refuse to float between facilities may result in termination of assignment.

Benefits:

• 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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