Registered Nurse - Utilization Review

Registered Nurse (RN) – Utilization Review & Utilization Management | Remote California 13-Week Contract

Join our healthcare team as a remote Registered Nurse Utilization Review specialist supporting acute and chronic diagnoses across inpatient, Extended Hospital Outpatient, and observation levels of care. This 13-week California nursing contract offers experienced utilization management nurses the opportunity to apply clinical judgment in a collaborative, multi-service environment while working Pacific Time.

Connected to Torrance, California, this remote nursing opportunity is associated with the welcoming South Bay region of Los Angeles, known for its coastal setting, convenient access to metropolitan amenities, and vibrant community atmosphere.

Remote Nursing Job Details

• Weekly Estimated Pay: $1,309–$1,454
• Contract Length: 13 weeks
• Work Arrangement: 100% remote Registered Nurse position
• Schedule: 8-hour day shifts, 5 shifts per week; 40 hours per week
• Available Hours: 8:00 a.m.–4:30 p.m. or 9:00 a.m.–5:30 p.m., Pacific Time
• Weekend Coverage: Every third weekend throughout the contract
• Time Zone: Pacific Time required
• Equipment: Laptop, keyboard, and mouse provided
• Patient Coverage: Approximately 1:40 during the day and weekends
• Call: Not required

Registered Nurse Utilization Review Requirements

• Active California Registered Nurse (RN) license
• At least 3 years of acute medical Care Manager or Utilization Review experience in a hospital setting
• Recent hospital-based utilization review experience; health plan or medical group-only experience does not meet the requirement
• Mandatory InterQual experience
• Recent Epic experience, preferably within the last 6–12 months
• Working knowledge of Medicare regulations and utilization management processes, including CC44s, ABNs, HINNs, and MCSNs
• Experience working with HMOs, IPAs, and related payer structures
• Flexibility to rotate support across three facilities
• Ability to work every third weekend and maintain strict adherence to California meal and rest break requirements
• Ability to work independently in a fully remote environment with strong attention to documentation and compliance

Utilization Management Nurse Responsibilities

• Perform comprehensive utilization reviews for inpatient, Extended Hospital Outpatient, and observation cases
• Apply InterQual criteria and clinical judgment to evaluate medical necessity, level of care, and continued stay needs
• Review adult and pediatric cases involving a broad range of acute and chronic diagnoses
• Use Epic to document reviews, clinical findings, determinations, and care coordination activities
• Apply Medicare-specific utilization management requirements, including processes related to CC44s, ABNs, HINNs, and MCSNs
• Collaborate with physicians, case management, clinical teams, and other stakeholders to support appropriate patient care and resource utilization
• Provide centralized utilization management support across multiple facilities and service lines
• Work scheduled weekend rotations and maintain dependable coverage during assigned shifts
• Follow California labor requirements and organizational policies, including taking scheduled breaks and obtaining approval before working additional hours

Apply now for this remote Registered Nurse Utilization Review opportunity supporting healthcare teams across Torrance and the South Bay region of California.

Benefits

401K with Matching, Healthcare, Dental and Vision

Equal Opportunity

We are an equal opportunity employer and value diversity across our organization. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.