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 | 800 AM – 430 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 135–45 (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 135–45 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) • Email • 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