Remote-RN-Utilization Review (Auto Offer)
Job Description: Travel Registered Nurse (RN) – Utilization Review (Auto Offer) Location: Apple Valley, CA 92307 Facility: Providence Saint Mary Medical Center – Case Management Department Duration: 13 Weeks (Possibility of Extension) (BI02) Shift: Day Shift | 8 Hours | 8:00 AM – 4:30 PM Pay Rate: $48 - 50 /hr on W2 Job Overview: We are seeking an experienced Travel Registered Nurse (RN) – Utilization Review to support an acute care Utilization Management and Case Management team. The ideal candidate will have strong hospital-based Utilization Review experience, InterQual expertise, and recent Epic EMR usage. This role involves high-volume utilization review, medical necessity determination, and coordination with physicians and interdisciplinary teams while ensuring compliance with Medicare, Medi-Cal, CMS, and regulatory standards across multiple acute care facilities. Key Responsibilities:
- Perform concurrent, retrospective, pre-certification, and continued stay reviews
- Apply InterQual Criteria to determine medical necessity and level of care (Hard Stop)
- Conduct utilization review for acute hospital patients
- Review appeals, denials, prior authorizations, and audits
- Ensure compliance with CMS, Medicare, Medi-Cal, HIPAA, and Joint Commission standards
- Support DRG validation, ICD-10 coding review, and admission criteria analysis
- Collaborate with physicians, case managers, and interdisciplinary teams
- Maintain patient ratio of 1:35–45 (Hard Stop requirement)
- Document all reviews accurately in Epic EMR (recent experience required)
- Support multiple facilities and rotating assignments as needed
- Participate in regulatory compliance and quality improvement initiatives
Required Skills & Experience:
- Minimum 3 years acute care Utilization Review / Case Management experience (hospital only)
- Strong InterQual experience (Hard Stop)
- Recent Epic EMR experience within last 6–12 months (Hard Stop)
- Experience with Medicare, Medi-Cal, CMS regulations
- Experience in concurrent, retrospective, and pre-certification review
- Knowledge of admission criteria, appeals, denials, and prior authorization
- DRG and ICD-10 coding knowledge
- Ability to manage 1:35–45 patient ratio
- Must be a seasoned travel nurse (Hard Stop)
Preferred Skills:
- ICU, Medical-Surgical, or Surgical Services experience
- HMO, IPA, managed care experience
- Knowledge of ABNs, HINNs, CC44s, MCSNs
- California Medi-Cal experience
- Strong analytical and communication skills
Required Certification:
- Active Registered Nurse (RN) license (CA or Compact, active by start date)
- BLS Certification (if required by facility)
- Valid Utilization Review / Case Management experience checklist
Work Setting:
- Acute Care Hospital
- Utilization Review / Case Management Department
- Centralized Multi-Facility UM Team
- Epic EMR environment
- Remote/Rotational facility support
Keywords: Registered Nurse, RN, Travel RN, Utilization Review Nurse, UM Nurse, Case Management RN, Acute Care Nurse, InterQual, Epic EMR, Medicare Compliance, Medi-Cal, CMS, DRG, ICD-10, CPT Coding, Prior Authorization, Appeals and Denials, Concurrent Review, Retrospective Review, Hospital Case Management, California Nursing Jobs, Apple Valley Nursing Jobs, Remote UR RN Physical Setting: Acute Care Hospital Utilization Review / Case Management Unit Multi-facility support environment Remote utilization review workflow Pay: $48.00 - $50.00 per hour Benefits:
- Health insurance
- Life insurance
Application Question(s):
- Available time to connect?
Experience:
- acute care Utilization Review / Case Management: 3 years (Required)
- EMR systems(Epic): 1 year (Required)
- Seasoned Traveler : 1 year (Required)
- InterQual Criteria : 1 year (Required)
License/Certification:
- California RN License (Required)
Work Location: Remote