Job Title: RN - Utilization Review (Remote)
Location: Remote Must work in Pacific Standard Time (PST)
Duration: 13 Weeks
Unit: Remote Utilization Management
Pay Rate: $54/hr (W2) or $57/hr (1099)
Shift & Schedule
Schedule: Monday to Friday, 5x8-Hour Days
Hours: 08:00 AM 04:30 PM (PST)
Weekend Requirement: Every third weekend
Position Summary
We are seeking a Registered Nurse (RN) with a strong background in Utilization Review to work remotely.
This role involves reviewing medical necessity, documentation, and level of care decisions across multiple hospitals and service lines.
Key Responsibilities
Perform utilization review for inpatient, observation, and extended outpatient cases
Apply InterQual criteria (required Hardstop )
Use Epic for documentation and review workflows (recent use within 6 12 months required)
Interpret and apply Medicare rules and documentation (e.g., CC44s, ABNs, HINNs, MCSNs)
Rotate across three hospital systems under centralized UM
Adhere to California labor laws (breaks, meals, and time reporting)
Required Qualifications
Active CA RN License
Minimum 3 years of acute care CM/UM experience in a hospital setting (not health plan or medical group)
InterQual experience (Hardstop)
Recent Epic use (within the last 6 12 months)
Strong understanding of Medicare, HMO, and IPA processes
High attention to detail, organizational, and communication skills
Comfortable working independently in a fully remote environment