Utilization Review Nurse

Job Description – RN Utilization Review (Remote)

We are hiring an experienced RN for a Utilization Review role .This is a 13-week contract, fully remote, supporting multiple facilities and working in Pacific Standard Time.

Key Responsibilities:

• Perform utilization review, concurrent and retrospective reviews.
• Assess medical necessity using InterQual (required).
• Complete prior authorizations, admission reviews, denials, and audits.
• Document reviews in Epic (recent experience required).
• Ensure compliance with CMS, Medicare, and regulatory guidelines.

Requirements:

• 3 years acute care UM/Care Manager experience in a hospital setting.
• Seasoned traveler (required).
• InterQual & Epic experience (Hardstop).
• Active CA RN license. Required

Details:

• Shift: Days, 5x8 (8 AM–4:30 PM)
• Contract: 13 weeks, remote
• Location: Apple Valley, CA (PST schedule)
• Weekends: Minimum 4 per contract