Travel RN - Case Management/Utilization Review - Utilization Review

Travel RN - Case Management/Utilization Review

American Traveler

Austin, Texas, United States

Position status: On Hold

Assignment type: travel

Shift: Days

Length (weeks): 13

Openings: 1

Start date: 2026-11-10

$1,759.50/week (estimated advertised weekly pay)

Description

American Traveler is hiring a remote Utilization Management RN requiring 2 years of acute care UM experience and a TX or compact RN license.

Details

• Fully remote position within a centralized Utilization Management department supporting 13 acute care and critical access hospitals
• Reviews admissions and service requests for prospective, concurrent, and retrospective medical necessity and reimbursement compliance
• Uses Cerner with Careport (Allscripts) EMR system
• Schedule runs 08:30 to 17:00
• 13-week assignment

Requirements

• Active RN license (TX or compact) required
• Current BLS certification (AHA) required
• Minimum 2 years acute care utilization management experience or equivalent required
• Proficiency with InterQual/MCG criteria and CMS regulations required
• Experience with payor portals, managed Medicare/Medicaid insurers, and Google Workspace preferred
• Remote work experience preferred
• Nursys verification required within 30 days prior to start
• Current license and primary source verification required within 30 days prior to start
• Must provide a US Social Security Number and US home address

Additional Information

• Provides case management and consultation for complex utilization review cases
• Assists staff with coding, documentation, precertification, reimbursement, and claims denial/appeal issues
• Assesses and coordinates discharge planning needs with the healthcare team
• May prepare statistical analysis and utilization review reports
• Oversees compliance with federally mandated and third-party payer utilization management rules
• Requires strong critical thinking, independent judgment, and ability to work in a fast-paced, stressful environment
• Must be comfortable using multiple technologies simultaneously
• Radius rule applies and may reduce pay rate for local candidates
• First-time travelers may be considered

Hours per week: 40

Hours per shift: 8